Online Application
Basic Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN
*
*I understand that Emerald Capital Funding will perform a soft credit pull. This will not harm my credit.
Date of Birth
*
-
Month
-
Day
Year
MM/DD/YYYY
Funding Purpose
Business Expansion
Inventory Purchase
Equipment Purchase
Marketing & Advertising
Working Capital / Cash Flow
Debt Consolidation
Other
Funding Amount Needed
Please Select
Less than $25,000
$25,000-$50,000
$50,000-$100,000
$100,000-$250,000
$250,000-$500,000
$500,000+
Business Details
Business Name
*
Doing Business As (DBA)
Business Type
Please Select
LLC
Sole Proprietorship
Corporation
Non Profit
LLP
Industry
Please Select
Retail
Restaurant/Food Service
Construction
Healthcare
Manufacturing
Professional Services
Technology
Other
Business Start Date
-
Month
-
Day
Year
Use first day of the month if date not known
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Financial Information
Average Monthly Revenue
Do you have any existing business loans or cash advances?
Please Select
Yes
No
Tax ID (EIN)
File Upload - Business Bank Statements (Last 4 months)
Please be prepared to upload the last 4 months of your bank statement. You can also reply and attach the business bank statements to the confirmation email you will receive after submitting the form.
File Upload
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