Business Information
Legal Business Name
*
Tax ID#
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Business Phone Number
*
Format: (000) 000-0000.
Primary Owner Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Owner's Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ownership Percentage
*
Owner Salesforce ID
SSN
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Requested Capital Amount
Requested Amount
*
Estimated Gross Annual Revenue
*
Preferred Capital Type
*
Please Select
Term Loan
Working Capital
Line of Credit
Revenue-Based Financing
Equipment Financing
Unsure
Industry Type
*
Will you be submitting your bank statements via this online form?
*
Please Select
Yes
No
Upload Documents
*
Browse Files
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Choose a file
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of
Signage Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
I Understand
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Crossfield Services. 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 and/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 Crossfield Services to transmit this application form, 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 credit or or financial institution, of any information relating to any of you, to Crossfield Services and to each of the Recipients, on its own behalf. I am providing my business cellphone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions with Crossfield Services and/or its affiliates on either medium. I also hereby consent to the receipt of text messages knowing that msg. and data rates may apply. I understand that consent to receive texts is not a condition of approval. I can expect approx. 10 msgs./month. I/we certify that all the information contained herein is complete, true and accurate.
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