Business Information
Company Name
*
DBA
Business Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Federal Tax ID (EIN)
*
Legal Entity Type
*
Please Select
Corporation
Sole Prop
LLC
Partnership
Non-Profit
Business Established Date
*
-
Month
-
Day
Year
Date
Product Or Service Sold
*
Owner Information
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
SSN
*
Approximate Credit Score
*
Ownership %
*
Please specify the best time and method to contact you during business hours
*
Is there an additional Owner
*
Please Select
Yes
No
Second owner Information
Full Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
SSN
*
DOB
*
-
Month
-
Day
Year
Date
Approximate Credit Score
*
Ownership %
*
Business Financials
Please Upload the last 4 months of business bank statements (all Accounts)
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Total Monthly Sales (CC, Cash, and Check)
*
Do you currently have any open Term Loan or merchant cash advances?
*
Please Select
Yes
No
Funding Amount Needed
*
Use of Funds
*
*
By clicking the submit button, I agree to the terms & conditions.
By signing below, the business listed above and each of its owners/officers signing below (individually and collectively, "you"): (I) certify that all information and documents submitted in connection with this application are true,correct and complete; and (ii) authorize BackStream Group & Simply Capital Source Inc. ("Simply Capital") and its representatives, successors, assigns, designees and third-party funding partners, which includes lenders and other finance providers with whom Simply Capital has, or may in the future enter into, commercial brokerage-financing relationships (collectively, "Recipients"): (1) 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: (2) to obtain the release, by any creditor or financial institution, of any information relating to any of you, to any Recipient, on its own behalf, (3) to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all Recipients for the foregoing purposes; and (4) to contact you via e-mail, call and/or text message at the e-mail address and/or phonenumber provided above, or at any e-mail address andlor phone number reasonably identified as belonging to you, including wireless numbers (if applicable), using an automated telephone dialing system or other similar system with respect to this application, future-related commercial-financing opportunities and/or other lawful telemarketing purposes.
Owner Signature
*
2nd Owner Signature
*
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