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Funding Application
Apply for business funding by providing your company and principal owner information. Complete all required fields to ensure a smooth application process.
Liquidity Engineer
*
Select an option
Roger Gill
Type of Funding Requested
*
Select funding type
Bridge Liquidity
Equipment Finance
Factoring / ABL
SBA / Working Capital
Strategic Term Loan
Business Information
Business Name
*
DBA Name
Legal Entity Type
Please Select
LLC
Corporation
Sole Proprietor
Partnership
Business Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Federal Tax ID
*
Business Street Address
*
Street Address Line 2
Business City
*
Business State
*
Business Zip Code
*
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Website
Industry
*
Gross Annual Sales
*
Total Monthly Sales
*
Average Monthly Credit Card Sales
*
Capital Profile
Total Capital Requested
*
When Do You Need the Capital?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Use of Funds
Please Select
Payroll
Working Capital
Line of Credit
Equipment
Expansion
Finance Receivables
Real Estate
Marketing
Start a business
Preferred Capital Term
Bridge Liquidity Details
Existing Advance Provider(s)
Current Daily Payment Amount
Current Position Number
Please Select
1st Position
2nd Position
3rd Position
4th Position or Higher
Equipment Finance Details
Equipment Description
Vendor / Equipment Seller Name
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Estimated Delivery Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Estimated Collateral Value
Factoring / ABL Details
Average Monthly Receivables Volume
Debtor Concentration
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of
Top 3 Customers by Revenue Percentage
SBA / Working Capital Details
Upload 3-Year Business Tax Returns
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of
Upload Personal Financial Statement
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of
Upload Personal Tax Returns (Last 2 Years)
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Existing Debt Schedule
Strategic Term Loan — Financial Package
Upload Business Tax Returns (3 Years)
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Upload Profit and Loss Statement
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Upload Balance Sheet
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Upload Debt Schedule
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Upload Global Cash Flow Summary
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Current Loan or Advance Outstanding
*
Landlord / Mortgage Company Name
Landlord Contact Name
Rent / Mortgage Payment
Principal Owner Information #1
First Name (Owner 1)
*
Last Name (Owner 1)
*
Percent of Ownership (Owner 1)
Mobile Phone (Owner 1)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone (Owner 1)
Please enter a valid phone number.
Format: (000) 000-0000.
Email (Owner 1)
*
example@example.com
Home Address (Owner 1)
*
Address Line 2 (Owner 1)
City (Owner 1)
State (Owner 1)
Zip Code (Owner 1)
Estimated Credit Score (Owner 1)
Please Select
500-550 Challenged
551-600 Fair
601-650 Good
651-700 Very Good
700+ Excellent
Property Ownership (Owner 1)
Own
Rent
Date of Birth (Owner 1)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number (Owner 1)
Driver's License # (Owner 1)
State of Issuance (Owner 1)
Does this business have a 2nd owner?
Yes
No
Principal Owner Information #2
First Name (Owner 2)
*
Last Name (Owner 2)
*
Percent of Ownership (Owner 2)
Mobile Phone (Owner 2)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone (Owner 2)
Please enter a valid phone number.
Format: (000) 000-0000.
Email (Owner 2)
*
example@example.com
Home Address (Owner 2)
*
Address Line 2 (Owner 2)
City (Owner 2)
State (Owner 2)
Zip Code (Owner 2)
Estimated Credit Score (Owner 2)
Please Select
500-550 Challenged
551-600 Fair
601-650 Good
651-700 Very Good
700+ Excellent
Property Ownership (Owner 2)
Own
Rent
Date of Birth (Owner 2)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number (Owner 2)
Driver's License # (Owner 2)
State of Issuance (Owner 2)
Does this business have a 3rd owner?
Yes
No
Principal Owner Information #3
First Name (Owner 3)
*
Last Name (Owner 3)
*
Percent of Ownership (Owner 3)
Mobile Phone (Owner 3)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone (Owner 3)
Please enter a valid phone number.
Format: (000) 000-0000.
Email (Owner 3)
*
example@example.com
Home Address (Owner 3)
*
Address Line 2 (Owner 3)
City (Owner 3)
State (Owner 3)
Zip Code (Owner 3)
Estimated Credit Score (Owner 3)
Please Select
500-550 Challenged
551-600 Fair
601-650 Good
651-700 Very Good
700+ Excellent
Property Ownership (Owner 3)
Own
Rent
Date of Birth (Owner 3)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number (Owner 3)
Driver's License # (Owner 3)
State of Issuance (Owner 3)
Authorization and Signatures
By signing below, each of the above listed business and business owner/officer (individually and collectively, you) authorize Strategic Corporate Services, INC (SCS) and each of its representatives, successors, assigns 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 therefor (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. You also authorize SCS to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of 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 SCS and to each of the Recipients, on its own behalf. You also authorize SCS and each of its Recipients to contact you via text message, automated call or email message at the contact information listed above.
Signature of Owner 1
*
Date (Owner 1)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Owner 2
Date (Owner 2)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Owner 3
Date (Owner 3)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload Government-Issued ID
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Upload Bank Statements (Last 4 Months)
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Save and Return Later
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