BB-Funding Application

Business Name

Name of business

Business DBA (If applicable)

DBA for Business

Business Phone

Please enter a valid phone number.

Business Email

example@example.com

Website

Business Website

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Entity Type

Home Based Business

YesNo

Business Start Date*

Formation Date

Industry Type

SIC CODE

Business Description

Tax ID*

State of Incorporation*

State

Open Judgments

YesNo

Open Bankruptcy

YesNo

Amount Requested

When are funds needed

ASAP30 days60+ days

Use of Funds

Gross Annual Sales

Gross Monthly Sales

Current Cash Advance

YesNo

Cash Advance Balance

Full Name*

First NameLast Name

Co-Owner Full Name

First NameLast Name

Address*

Home Address

Street Address Line 2

CityState

Postal / Zip Code

Co-Owner Address

Home Address

Street Address Line 2

CityState

Postal / Zip Code

Title*

Owner/President/Etc.

Co-Owner Title

Owner/President/Etc.

Percentage Ownership*

Co-Owner Percentage Ownership

Home Phone

Please enter a valid phone number.

Co-Owner Home Phone

Please enter a valid phone number.

Mobile Phone

Please enter a valid phone number.

Co-Owner Mobile Phone

Please enter a valid phone number.

Date Of Birth*

Date

Co-Owner Date Of Birth

Date

SSN

Social Security Number

Co-Owner SSN

Social Security Number

By signing below, each of the above-listed business and business owner/officer (individually and collectively, “you”) authorize Business Butter LLC, Black Tie Funding LLC, and each of its representatives, successors, assignees, and designees (“Recipients”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables, including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) to obtain, consumer or personal, business, and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian, and Equifax, and from other credit bureaus, banks, creditors, and other third parties.
Since Busines Butter LLC does not charge its clients any fees it does have a “Claw Back Clause” If you cause the lender to claw back any commissions earned from
facilitating the loan you shall be held responsible for any and all pertaining monitory damages caused by lender. You also authorize Business Butter LLC to transmit
this application form and any of the foregoing information obtained in connection with this application to any or all the Recipients for the foregoing purposes. You
also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Business Butter LLC and to each of the Recipients, on
its own behalf.

Owner Signature

Co-Owner Signature

Date

Signature date

co-owner date

Date

Last 4 Months Business Bank Statements