A-TIER ADVANCE FORM
Please fill out all boxes below:
BUSINESS NAME
DBA
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BUSINESS START DATE UNDER CURRENT OWNERSHIP
STATE OF INCORPORATION
FEDERAL TAX-ID
MERCHANT/OWNER %
TYPE OF ENTITY
Is your entity an LLC, Partnership, Sole Proprietorship, Corporation, or OTHER?
MONTHLY GROSS REVENUE
ANNUAL-GROSS REVENUE
REQUESTED AMOUNT
PURPOSE OF FUNDS
INDUSTRY TYPE OR PRODUCTS/SERVICES SOLD
CURRENT CREDIT SCORE
MERCHANT/OWNER DATE OF BIRTH
MERCHANT/OWNER HOME ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
Please Insert your 9-digit SSN above
REPRESENTATIVE NAME
Signature
DATE OF SIGNATURES
Authorization & Disclosure
By signing and submitting this application above, the Merchant and its Owner(s)/Guarantor(s) authorize A-TIER ADVANCE LLC and its representatives, agents, funders, and assigns to:
Obtain consumer and/or business credit reports from credit reporting agencies, including but not limited to Experian, TransUnion, and Equifax, for the purpose of evaluating this application and for any subsequent updates, renewals, or collections. Soft Credit Pulls only. Verify all information provided in this application, including but not limited to bank statements, credit card processing statements, financial records, and business information. Contact any references, banks, landlords, or other parties listed to obtain information related to the business and its operations. Receive and exchange information about the Merchant and Owner(s) with third-party funding sources, brokers, and financial institutions for the purpose of securing financing. Obtain banking and/or payment processing history directly from financial institutions. The Merchant and Owner(s) certify that all information provided is true, accurate, and complete. Any misrepresentation may result in denial of funding or legal action. A copy, facsimile, or electronic signature of this authorization shall be deemed as valid as the original. By submitting this application, you acknowledge and agree to the above terms.
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