Merix Capital Group Business Funding Application

BUSINESS FUNDING APPLICATION

Please complete this application form to apply for business funding.
Legal Business Name*
DBA (Doing Business As)
Legal Entity*
Sole Proprietorship, Corporation, Partnership, LLC
Industry*
Federal Tax ID (EIN)*
Business Inception Date*

MonthDayYear
Date
Monthly Total Sales*
Business Mobile*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Business Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Use of Funds*
Do you currently have any open loans?*
Company Balance
Owner/Principal Information
Owner/Principal Name*

First NameLast Name
Credit Score*
Title / Percentage (%) of Ownership*
Date of Birth*

MonthDayYear
Date
Social Security Number*
Owner/Principal Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Personal Mobile*
Please enter a valid phone number.Format: (000) 000-0000.
Second Owner Details (Optional)
Second Owner Name

First NameLast Name
Second Owner Title / Percentage of Ownership
Second Owner Social Security Number
Second Owner Date of Birth

MonthDayYear
Date
Second Owner Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Second Owner Personal Mobile
Please enter a valid phone number.Format: (000) 000-0000.
Primary Owner Signature*
Second Owner Signature (if applicable)
Date*

MonthDayYear
Date
Upload Current Bank Statements (Past 4 Months)

Cancelof
Each of the undersigned, who is either a Principal, Sole Proprietor, or Personal Guarantor of the above-named business, recognizes that his or her credit history may be a factor in evaluating this application of the above-named business for funding. Each of the undersigned hereby authorizes Merix Capital Group Inc and its assigns, representatives and/or affiliate partners of Merix Capital Group to obtain his or her credit report (and any updates to his or her credit report) in connection with Merix Capital Group's consideration of this application and any affiliate partners or representatives of Merix Capital Group in connection with any subsequent review of the account of the above-named business for the purpose of obtaining commercial loans having daily repayment features or purchases of future receivables including Revenue-based Financing transactions. Each undersigned authorizes Merix Capital Group to utilize information including but not limited to calls, emails, texts, and direct mail for marketing efforts from Merix Capital Group and affiliates.
Should be Empty:

BUSINESS FUNDING APPLICATION

Owner/Principal Information

Second Owner Details (Optional)