Business Funding Application- Part 1 Financial Information
Amount Requested
*
Credit Score (Approximate)
Average Monthly Revenue
*
Existing Loan(s)
*
Yes
No
Total Annual Revenue (every 12 months)
*
Average Monthly Sales
Business Information
Business Legal Name
*
DBA Name
EIN
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone
*
Format: (000) 000-0000.
Legal Entity Type
*
Please Select
Sole Proprietor
Partnership
Limited Liability Corp (LLC)
C Corp
S Corp
Business Start Date
*
/
Month
/
Day
Year
Date
Industry Type
*
Please Select
Construction
Cannabis
Cleaning & Janitorial
Convenience Stores
Take-Out Restaurants
Liquor Stores
Educational Services
Medical & Health Industries
Pharmaceutical
Technology
Grocery-Food Distribution
Landscaping
Auto Repair Services
Dry Cleaning & Laundry Services
Law Firms
Owner Information
First Name
*
Last Name
*
SSN
*
Date of Birth
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Ownership % (Enter a # from 1 - 100)
Please enter a number from 1 to 100.
Business Owner E-Sign
*
Please enter a brief description for use of funds if approved.
Attach the last 3 months of Full Bank Statements
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