Wellspring Capital Form

Wellspring Capital Corp.

Application Form

40 Broad Street, New York, New York 10004
What Are you Interested On

Business Line Of Credit 1-3 Year TermPPRF Term Loan 2-10 Year TermSBA Term Loan 2-10 Year TermInmediate Financing Up to 3 Year TermFactoring Invoices
BUSINESS NAME*
DBA
EMAIL*
example@example.com
PHONE*

Area CodePhone Number
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PRE-QUALIFY

Let's make sure you get qualified for something.
FEDERAL TAX ID*
BUSINESS START DATE UNDER CURRENT OWNERSHIP*

MonthDayYear
Date
STATE OF INCORPORATION OR ORGANIZATION*
How many employees under W-2 do you have?
TYPE OF ENTITY*
MONTHLY GROSS*
REQUESTED AMOUNT*
PRODUCTS OR SERVICES SOLD*
GROSS ANNUAL SALES*
CURRENT CREDIT SCORE*
Brief description of usage of funds.*
Current Balances and Payments.

MERCHANT/OWNER INFORMATION

let's make sure only you are applying for this.
OWNER NAME*
TITLE*
OWNERSHIP %*
Social Security Number: *
(We WILL NOT run your credit) this is so we can confirm there is no criminal background and that no one else is applying on your behalf.
HOME ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DATE OF BIRTH*

MonthDayYear
Date
PHONE

Area CodePhone Number

PARTNER INFORMATION

If you are 100% owner please skip this page.
PARTNER NAME
PARTNER TITLE
PARTNER OWNERSHIP %
PARTNER SSN
PARTNER HOME ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARTNER DATE OF BIRTH

MonthDayYear
Date
PARTNER PHONE

Area CodePhone Number

STATEMENTS

You can attach the statements here or directly on the email Thread.
BUSINESS BANK STATEMENT #1

Browse Files

Cancelof
BUSINESS BANK STATEMENT #2

Browse Files

Cancelof
BUSINESS BANK STATEMENT #3

Browse Files

Cancelof
BUSINESS BANK STATEMENT #4

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Cancelof
By signing below, each of the above listed business and business owner/officer (individually and collectively, "Applicant") certifies that the Applicant is an authorized owner of the above-named business and that all information provided in this application is true and accurate. Applicant shall immediately notify dba Wellspring Capital Corp. of any change in such information or financial condition.
Applicant authorizes Wellspring Capital Corp. and each of its representatives, successors, assigns and designees ("Recipients") to share this application and any information submitted/obtained in connection with it with any other parties that may be involved with or acquire commercial business loans having daily/weekly repayment features or purchases of future receivables, including Merchant Cash Advance transactions (collectively, "Transactions").
Applicant further authorizes Wellspring Capital Corp. and all Recipients to obtain consumer and/or personal, business and investigative reports and other information about Applicant, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian, and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Wellspring Capital Corp. and to each of the Recipients, on its own behalf.
You are providing your business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions with Wellspring Capital Corp. and/or its affiliates on either medium. You also hereby consent to the receipt of text messages knowing that msg and data rates may apply (approximately 10 msgs/month).
Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of the information obtained in connection with this application.
Your signature above certifies that you are authorized to sign this application on behalf of the Business and all the information contained herein is complete, true and accurate.
Representative Name*
SIGNATURE*

Clear
Use your mouse or finger to draw your signature above
DATE*

MonthDayYear
Date
SECOND OWNER SIGNATURE

Clear
Use your mouse or finger to draw your signature above
DATE

MonthDayYear
Date
Should be Empty:

PRE-QUALIFY

MERCHANT/OWNER INFORMATION

PARTNER INFORMATION

STATEMENTS