Clone of Defynitive Solutions, Inc.

Capital Request Application
Legal/Corporate Name or DBA:
A corporate name is the name under which an entity is formed, or registered. In most cases, corporate names ends with a distinct suffix (i.e., Inc., LP, LLC, etc.). A trade name is a fictitious/alternate name under which an entity may choose to operate.
Business Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Desired Funding Amount:
Business Structure
Industry:
EIN/Tax ID:
An Employer Identification Number (EIN) is a unique number assigned to a business for easy IRS identification for tax reporting purposes.
Primary Contact Person:

First NameLast Name
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Business Email:
example@example.com
Company Website:
BUSINESS OWNERSHIP
Number of Owners
Owner #1 (Personal Guarantor)

First NameLast Name
Ownership Percentage
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Social Security Number
Estimated FICO Score
How Many Advances/Loans Do You Currently Have?
Please upload Business bank statements

4 MOST RECENT bank statements July, August, September, and October 2026 from the BUSINESS CHECKING account.
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Please upload Valid government-issued ID

Color copy (picture from your mobile phone) of your government issued ID or Driver's license.
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Please upload Voided check or bank letter

Voided Check or Bank Letter.
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By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted in connection with this application are true, correct, and complete; and (2) authorize Defynitive Solutions, Inc, its agents, partners, representatives and lenders to obtain/receive credit reports and any other information regarding the Merchant and its owners/principals from third parties, in order to verify any information provided on the application, that may be involved with or acquire commercial loans having daily repayment features or purchases of future receipts including Merchant Cash Advance transactions.
Agreement & Consultation Fee Acknowledgment
Professional Services
By checking this box and submitting this application, I (“Applicant”) acknowledge and agree to the following terms regarding consultation fees associated with certain funding solutions facilitated by DSI.

Funding Types Subject to Consultation Fee

I understand that a consultation fee applies only if I receive funding through any of the following solutions arranged, introduced, or facilitated by DSI:

Lines of credit

Term loans with a factor rate of 1.30 or lower

Equity-based debt financing

Consultation Fee Schedule

I agree that, if funded under the qualifying solutions listed above, I will pay a consultation fee to DSI based on the total amount funded, as outlined below:

10% for funding up to $50,000.00

8% for funding between $50,001.00 – $100,000.00

6% for funding between $100,001.00 – $150,000.00

4% for funding between $150,001.00 – $500,000.00

2% for funding of $500,001.00 or greater

I understand that this consultation fee is earned and due in full once funds are successfully deposited, disbursed, or otherwise issued to me or my business.

Payment Timing

I agree that the consultation fee must be paid within forty-eight (48) hours of funding being deposited or made available.

Non-Payment and Potential Consequences

I understand that failure to remit the consultation fee within the required timeframe may result in one or more of the following actions, to the extent permitted by applicable law:

Issuance of a payment reminder and formal demand for payment

Assessment of reasonable late fees, interest, or administrative costs

Referral of the outstanding balance to a third-party collections agency

Reporting of the delinquent obligation to business and/or personal credit reporting agencies, which may negatively impact my business credit and personal credit profile

Initiation of legal action to recover the unpaid amount, including reasonable attorneys’ fees and court costs

Suspension or termination of current and future services provided by DSI

I acknowledge that timely payment of the consultation fee helps ensure continued access to funding assistance and support from DSI.

By checking this box, I confirm that I have read, understand, and agree to the terms outlined above.
Name

First NameLast Name
Title
Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Capital Request Application

BUSINESS OWNERSHIP