Business HELOC Application
Business Information
Business Name
*
Trade Name (DBA)
Type of Entity
*
Please Select
Corporation
LLC
Partnership
Sole Proprietorship
Nonprofit
Other
Industry
*
Please Select
Restaurants
Agriculture, Forestry, Fishing and Hunting
Trucking & freight
Leisure Tourism
Travel Arrangements
Interior Design/Event Planning
Information Technology (IT)
Industrial Machinery
Manufacturing
Aviation
Real Estate
Farming
Transportation
Real Estate Management
Construction
Auto repair shops
Retail stores (independent)
Medical practices
Wholesale
Dental practices
Jewelry Manufacturer
Convenience stores / bodegas
Beauty School
Salons & barber shops
Bars & nightclubs
Insurance
HVAC contractors
Plumbing
Electrical
Roofing
Landscaping / lawn care
Hotels & motels
Marketing
Consulting
Professional Services
Auto dealerships (used)
Body shops / collision repair
Tire shops
Towing companies
Liquor stores
Gas stations
Grocery stores (independent)
Pharmacies (independent)
Spas & med spas
Gyms & fitness centers
Yoga / pilates studios
Veterinary clinics
Daycare / childcare centers
Dry cleaners
Laundromats
Bakeries
Pizza shops
Food trucks
Catering companies
Coffee shops / cafes
Cleaning services (commercial / janitorial)
Security / guard services
Staffing agencies
Print shops
Sign shops
Florists
Jewelry stores
Furniture stores
Clothing / apparel retail
Pet stores / grooming
Pest control
Pool services & supply
Smoke shops / vape shops
E-commerce / Amazon sellers
Waste Management
Security System Service
Other
Business Tax ID (EIN)
*
Business Address
*
Applicant Information
Name
*
First Name
Last Name
HELOC Property Address
*
Primary Address
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
SSN
*
Annual Income
*
Total Liquid Assets
*
Add additional owner
Please Confirm
*
The Merchant and Owner(s)/Officer(s) identified above (individually, an "Applicant") each represents, acknowledges and agrees that (1) all information and documents provided to VCA Capital Advisors Inc. ("Representative"), including credit card processor statements, are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or in Applicant's financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain, including credit reports, to other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial funding having daily repayment features or purchases of future receivables, including Merchant Cash Advance transactions and the applications therefor (collectively, "Transactions"), and each Assignee is authorized to use such information and documents, and to share them with other Assignees, in connection with potential Transactions, (4) Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, "Recipients") are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any other information providers arising from any act or omission relating to the requesting, receiving, or release of information, (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant, (8) Applicant consents to receive marketing calls and texts from Representative and its affiliates or assigns using automated technology, and consent is not a condition of funding, and (9) Representative charges a success fee equal to six percent (6%) of the total funded amount of any Transaction, which is earned and payable upon successful closing of that Transaction, and no fee is owed if no Transaction closes. A copy of this authorization may be accepted as an original. Applicant further agrees to the use of electronic signatures to execute this document, including the use of specialized electronic signature platforms.
Signature
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
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