BUSINESS FUNDING APPLICATION FORM

Anderson Tax & Business Solutions

Complete this secure funding application to determine your eligibility for business funding opportunities. All information is confidential and securely processed.
Full Legal Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
SSN (for soft credit check)*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Name*
LLCSole ProprietorCorporationPartnership
EIN (if applicable)*
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date Business Started*

MonthDayYear
Date
Tax ServicesRetailTransportationConstructionOther
$1,000 – $10,000$10,000 – $25,000$25,000 – $50,000$50,000 – $100,000$100,000+
Startup CostsInventoryEquipmentMarketingPayrollExpansion
Below 580580–620620–680680–740740+
Late PaymentsCollectionsCharge-offsBankruptciesNoneOther
$0 – $5,000$5,000 – $10,000$10,000 – $25,000$25,000+
YesNo
Upload last 3 months bank statements

Cancelof
Business Bank Name*
Less than 3 months3–6 months6–12 months1+ year
YesNo
Amount
Lender Name
Current Balance*
Business Bank AccountEINBusiness WebsiteBusiness Phone Number
Driver’s License*

Cancelof
EIN Letter (CP 575)*

Cancelof
Business Documents*

Cancelof
Voided Check (optional)

Cancelof
DISCLOSURE (IMPORTANT)

I understand this is a funding qualification application and not a guarantee of approval. I authorize Anderson Tax & Business Solutions to review my information and connect me with funding options.
Do you agree to the terms?*
Consent Statement: I confirm that the information provided is accurate to the best of my knowledge. I authorize Anderson Tax & Business Solutions to prepare my tax return.
E-Signature
Today's Date*

MonthDayYear
Date
Should be Empty:

Anderson Tax & Business Solutions