Chelsea Bridge Advisors Funding Application

Funding Application
Step 1 of 4: Contact Information
Business Legal Name*
Doing Business As
Phone Number*
Fax Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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, each of the above-listed businesses and business owner/officer (individually and collectively, “you”) authorize Chelsea Bridge Advisors Inc. and each of its representatives, successors, assigns, and designees (“Recipients”) that may be involved with or acquire commercial business loans having daily/weekly repayment features or purchases of future receivables, including Revenue-Based Financing transactions (collectively, “Transactions”), to obtain consumer, personal, business, and investigative reports and other information about you, including credit card processor and bank statements, from one or more consumer reporting agencies such as TransUnion, Experian, and Equifax, and from other credit bureaus, banks, creditors, and third parties. You also authorize Chelsea Bridge Advisors Inc. to transmit this Application, along with any related information submitted or obtained in connection with it, to any or all Recipients for the foregoing purposes, and consent to the release by any creditor or financial institution of information relating to any of you to Chelsea Bridge Advisors Inc. and each of the Recipients. You intend to sign this Application electronically and consent to transacting business with Chelsea Bridge Advisors Inc. and its affiliates electronically. You are providing your business cell phone and business e-mail address and consent to receive correspondence or messages regarding transactions via either medium, including text messages (approximately 10 msgs/month; message and data rates may apply). You understand that consent to conduct business via electronic signatures and to receive text messages are not conditions of approval and that you may opt out of either or both by contacting support@chelseabridgeadvisors.com . Your signature below certifies that you are authorized to sign this Application on behalf of the Business and that all information provided is complete, true, and accurate.
Step 4 of 4: Signature(s)
Owner 1
Signature*

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Title*
Print Name*
Date*

MonthDayYear
Date
Owner 2
Signature

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Title
Print Name
Date

MonthDayYear
Date
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Funding Application

Step 1 of 4: Contact Information

Step 2 of 4: Business Information

Step 3 of 4: Ownership Information

Owner 1

Owner 2

Disclosure

Step 4 of 4: Signature(s)

Owner 1

Owner 2