BrightLine Advance Business Funding Application
Business Funding Application
BUSINESS INFORMATION
Legal Business Name
*
DBA
Business Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Email
*
example@example.com
Website
Federal Tax ID / EIN
*
Business Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Start Date
*
-
Month
-
Day
Year
Date
Monthly Revenue
*
Requested Amount
*
Legal Entity
*
Please Select
LLC
Corporation
Sole Proprietor
Partnership
Industry
*
Please Select
Accounting Services
Advertising & Marketing
Agriculture
Airlines & Aviation
Architectural Services
Arts & Entertainment
Automotive Repair
Bakery
Banking
Beauty Salon & Barber Shop
Biotechnology
Business Consulting
Cannabis
Cleaning Services
Construction
Convenience Store
Cosmetics
Cybersecurity
Data & Analytics
Defense & Space
Education & Training
Electrical Contractor
E-Commerce
Energy & Utilities
Engineering Services
Environmental Services
Event Services
Facilities Services
Financial Services
Fitness & Gym
Food & Beverage
Freight & Logistics
Gaming
Gas Station
General Contractor
Government
Graphic Design
Grocery Store
Healthcare & Medical
Home Improvement
Hospitality
HR & Staffing
HVAC
Insurance
Interior Design
Internet & Software
IT Services
Janitorial Services
Landscaping
Legal Services
Manufacturing
Media & Publishing
Moving & Storage
Nonprofit
Pharmaceuticals
Plumbing
Printing Services
Property Management
Public Relations
Real Estate
Recreation & Leisure
Recruiting
Restaurant
Retail Store
Roofing
Security Services
Social Services
Sports
Staffing & Recruiting
Technology & IT Services
Telecommunications
Transportation & Trucking
Travel & Tourism
Veterinary Services
Wholesale
Other
Use of Funds
*
Please Select
Working Capital
Equipment
Expansion
Payroll
Inventory
Other
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Next
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Owner Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Title
*
SSN#
*
Date of Birth
*
-
Month
-
Day
Year
Date
Ownership %
*
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Second Owner Name
First Name
Last Name
Second Owner Title
*
Second Owner Date of Birth
*
-
Month
-
Day
Year
Date
Second Owner Ownership %
*
Second owner address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Second Owner Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Second Owner Email Address
*
example@example.com
UPLOADS
Last 4 Months Bank Statements
*
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SIGNATURE
Applicant certifies the information provided on this application is true and complete to the best of applicant's knowledge.
Applicant Signature
*
Date
*
-
Month
-
Day
Year
Date
Printed Name
*
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Submit
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