GENTIC CAPITAL

GENTIC CAPITAL APPLICATION FORM
- Legal / Corporate Name
  
  First NameLast Name
- DBA (if applicable)
- Federal Tax ID (EIN)
- Legal Entity Type
- Business
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Business Establishment Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Average Monthly Deposit Count
- Average Monthly Revenue
- Do you currently have any open merchant cash advances?
- Primary Use of Funds
- Have you been declined for funding in the last 6 months?
- Ownership Structure
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Social Security Number
- Approximate Credit Score
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Social Security Number
- Approximate Credit Score
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Owner Signature
- Signature
- I agree to receive SMS updates
- By submitting this application, the undersigned owner(s) authorise Gentic Capital and its representatives, successors, assigns and designees to obtain consumer reports, verify business and personal information, and contact the applicant(s) by phone, email or text regarding this application. The undersigned further authorise Gentic Capital to share this information with funding partners and service providers for the purpose of evaluating this application. The information provided is certified as true and accurate to the best of the applicant's knowledge.
  
  I agree to receive SMS updates about my application from Gentic Capital. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out.
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GENTIC CAPITAL APPLICATION FORM