Apex Choice Submission

Apex Choice Submission
Federal Tax ID*
Business DBA
Business Legal Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Start Date*

MonthDayYear
Date
State of Incorporation*
Business Phone
Email
Cell Phone
Please enter a valid phone number.
Website
Product Service Sold*
Entity Type (Sole Prop, LLC, LLP or Corp)
Annual Gross Sales
Preferred Financial Option*

Merchant Cash AdvanceTerm Loan Secured/UnsecuredLine Of CreditEquity Loan (HELCO)
Do you have a cash advance loan now

YesNo
Reason for Working Capital
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone *
Please enter a valid phone number.
% of Ownership*
Date Of Birth*

MonthDayYear
Date
Title*
SSN*
Credit Score
Second Owner Name

First NameLast Name
Second Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Owner Phone
Please enter a valid phone number.
% Of Second Ownership
Second Owner Title
Second Owner Date Of Birth

MonthDayYear
Date
Second Owner SSN
Second Owner Credit Score
Officer #1 Print*
Signature*

Clear
Title*
Date*

MonthDayYear
Date
Officer #2 Print
Signature

Clear
Title
Date

MonthDayYear
Date
Last 4 Months Of Bank Statements*

Cancelof
Authorization & Consent

By signing, faxing, or emailing this application, you certify that:

You are authorized to apply on behalf of the company named in the Company Information section of this application.
All information provided in this application and any supporting documents is true, accurate, and complete to the best of your knowledge, and you will promptly notify us of any material changes.

You understand and agree that we, our agents, and our assignees are authorized to:

Contact third parties to verify and evaluate your application.
Request personal and/or business credit reports from credit reporting agencies and other sources for the purposes of application review, credit updates, renewals, extensions, or other lawful purposes.
Share relevant credit and application information with third parties who may offer credit or other products and services to you or your company.

Upon request, we will inform you if a credit report was obtained and provide the name and address of the reporting agency.

By clicking “Continue”, you also consent to receive marketing calls and text messages including those made via automated dialing systems or prerecorded messages from Liberty Bell Capital Inc. at the phone number you provided. Consent is not a condition of purchase. Standard message and data rates may apply.
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