CAPTAIN CAPITAL GROUP APP

Business Information
Legal / Corporate Name*
DBA (if applicable)
Business Address*

Street Address

CityState

Zip Code
Federal Tax ID (EIN #)*
9 digits
Legal Entity Type*
Business Establish Date*

MonthDayYear
Date
Products or Services Sold*
Owner Information
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Home Address*

Street Address

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
SSN #*
Approximate Credit Score*
Enter your estimated credit score.
Ownership %*
Please specify the best time and method to contact you during business hours*
Is there an additional owner?*
2nd Owner Information
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Home Address*

Street Address

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
SSN #*
Approximate Credit Score*
Enter your estimated credit score.
Ownership %*
Business Financials
Please upload the last 4 months of business bank statements

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Total Monthly Sales (CC, Cash, and Check)*
Do you currently have any open merchant cash advances?*
Please list the current cash advance company, daily/weekly payment amount, and approximate remaining balance
Funding Amount Requested*
Please upload a copy of your drivers license and voided check(s)

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Owner Signature*
Should be Empty: