Prime Funding Group Application

Funding Application

Prime Funding Group LLC
Business Name*
Business DBA
Legal Entity Type*
Tax ID / EIN*
Type of Business / Industry*
Industry
Business Phone*
E-mail*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Start Date*

MonthDayYear
Monthly Revenue*
Requested Amount*
Outstanding Business Loans*
Number of Positions
Use of Funds*

Ownership Info
Owner Name*

First NameLast Name
Business Title*
Date of Birth*

MonthDayYear
Social Security Number*
Mobile Number*
Please enter a valid phone number.
Owner Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ownership Percentage*
Owner 2 Name

First NameLast Name
Owner 2 Date of Birth

MonthDayYear
Owner 2 Social Security Number
Owner 2 Mobile Number
Please enter a valid phone number.
Owner 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 1 Signature*

Powered by Jotform SignClear
Date Signed*

MonthDayYear
Authorizations: By signing below, each of the above listed business owners (individually and collectively, "you") authorize (1) Prime Funding Group and its affiliates, successors, assigns and designees ("recipients") to obtain consumer, personal and business reports and other information about you, including but not limited to 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. (2) You also authorize Prime Funding Group to transmit this Application, along with any information obtained in connection with this Application, excluding consumer credit reports, to any or all of the Recipients. Further, you give Prime Funding Group, or an agent acting on its behalf, permission to email, call and/or send you SMS messages at the email and phone number(s) provided above or at any email address and/or phone number reasonably identified as belonging to you, including your wireless number, even if listed on a Do-Not-Call registry, using an automated telephone dialing system or other similar systems for marketing purposes. (3) You also certify that all information provided herein together with the supporting documents is true, accurate and complete and all such information may be relied upon by Prime Funding Group and their Recipients.
Should be Empty:

Funding Application

Ownership Info