Chelsea Bridge Advisors Funding Application

Step 2 of 4: Business Information
Type of Entity (Check One)*

Sole ProprietorshipLimited PartnershipPartnershipLLCLLPCorporation
Federal Tax ID: (Social Security Number if you’re a Sole Proprietorship)*
Business Start Date*

MonthDayYear
Date
Length of Ownership*
Industry*
Average Monthly Revenue: (Last 3 Months)*
Average CC Sales
Requested Amount*
Use of Funds*
Do you currently have any other business advances or loans?*

YesNo
If yes, please list
Landlord/Mortgage Company
Monthly Rent/Mortgage Payment
Contact Name
Phone Number

Step 3 of 4: Ownership Information

Must be completed by the owner(s) holding a combined 51% or more of the business
Owner 1
Name*

First NameLast Name
Title
Social Security Number*
Date of Birth*

MonthDayYear
Date
% of Ownership*
Credit
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 2
Name

First NameLast Name
Title
Social Security Number
Date of Birth

MonthDayYear
Date
% of Ownership
Credit
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Disclosure
By signing below, the undersigned certifies that all information provided in this application is true and correct. The undersigned authorizes Chelsea Bridge Advisors and its designated funding partners to obtain credit, bank, and other necessary information about the business and its owners to evaluate this application. This authorization includes obtaining consumer and/or business credit reports, contacting trade references, and verifying any information provided. The undersigned understands this is an application for business funding and not a guarantee of approval.
Step 4 of 4: Signature(s)
Owner 1
Print Name*
Title*
Date*

MonthDayYear
Date
Signature*

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Owner 2
Print Name
Title
Date

MonthDayYear
Date
Signature

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Funding Application