Purpose Fund - Business Funding Application

Business Information
Legal Business Name
Entity Name
Business DBA
DBA
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email
example@example.com
Federal Tax ID
EIN
Date Business Started

MonthDayYear
Date
Industry
Select Your Industry
Merchant Details
Primary Owner Full Name

First NameLast Name
Ownership Shares % (Primary Owner)
Primary Owner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Owner Email
example@example.com
Primary Owner Date of Birth

MonthDayYear
Date
Primary Owner Social Security Number (Last 4 digits only)
Merchant Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Merchant Details (Second Owner) - If Applicable
Second Owner Full Name

First NameLast Name
Ownership Shares % (Second Owner)
Second Owner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Second Owner Email
example@example.com
Second Owner Date of Birth

MonthDayYear
Date
Second Owner Social Security Number (Last 4 digits only)
Upload 3–4 Months of Business Bank Statements

For NY, UT, VA, CA - 4 months bank statements required
Cancelof
Date of Signing

MonthDayYear
Date
Signature
Should be Empty: