Business Funding Application
Business Information
Date
/
Month
/
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Legal/Corporate Name
*
DBA
(If Applicable)
Years in business?
*
3 months - 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
31 years
32 years
33 years
34 years
35 years
36 years
37 years
38 years
39 years
40+ years
State of Incorporation
*
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country?
*
United States
Canada
Federal Tax ID?
*
Applying as
*
Sole Proprietor
Partnership
Corporation
LLC
Other
Type of business or industry?
*
Which of our funding specialists have you spoken with?
*
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Business Funding Application
Personal Information
Owner #1
Full Name
*
First Name
Last Name
Best Contact Number
*
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Social Security Number
*
Equity Percentage
*
100%
99%
98%
97%
96%
95%
94%
93%
92%
91%
90%
89%
88%
87%
86%
85%
84%
83%
82%
81%
80%
79%
78%
77%
76%
75%
74%
73%
72%
71%
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69%
68%
67%
66%
65%
64%
63%
62%
61%
60%
59%
58%
57%
56%
55%
54%
53%
52%
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50%
49%
48%
47%
46%
45%
44%
43%
42%
41%
40%
39%
38%
37%
36%
35%
34%
33%
32%
31%
30%
29%
28%
27%
26%
25%
24%
23%
22%
21%
20%
19%
18%
17%
16%
15%
14%
13%
12%
11%
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
Owner #2
(If Applicable)
Full Name
First Name
Last Name
Best Contact Number
Email
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Social Security Number
Equity Percentage
100%
99%
98%
97%
96%
95%
94%
93%
92%
91%
90%
89%
88%
87%
86%
85%
84%
83%
82%
81%
80%
79%
78%
77%
76%
75%
74%
73%
72%
71%
70%
69%
68%
67%
66%
65%
64%
63%
62%
61%
60%
59%
58%
57%
56%
55%
54%
53%
52%
51%
50%
49%
48%
47%
46%
45%
44%
43%
42%
41%
40%
39%
38%
37%
36%
35%
34%
33%
32%
31%
30%
29%
28%
27%
26%
25%
24%
23%
22%
21%
20%
19%
18%
17%
16%
15%
14%
13%
12%
11%
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
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Business Funding Application
Financial Information
Financial Documentation
Click to Upload Files
Please attach your most recent 4 months of business bank statements from all operating accounts.
Cancel
of
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Business Funding Application
Sign and Submit
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Pay Less Business Funding and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily, weekly, bi-weekly or monthly 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 Trans Union, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Pay Less Business Funding 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 creditor or financial institution, of any information relating to any of you, to Pay Less Business Funding. And to each of the Recipients, on its own behalf. I am providing my business cell phone and business e-mail address and here by consent to the receipt of correspondence/messages regarding transactions with Pay Less Business Funding and/or its affiliates on either medium. I also here by consent to the receipt of text messages knowing that msg. and data rates may apply. You also 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.
*
Yes
Owner #1 Signature
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Pay Less Business Funding.. and each of its representatives, successors ,assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily, weekly, bi-weekly or monthly 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 Trans Union, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Pay Less Business Funding 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 creditor or financial institution, of any information relating to any of you, to Pay Less Business Funding. And to each of the Recipients, on its own behalf. I am providing my business cell phone and business e-mail address and here by consent to the receipt of correspondence/messages regarding transactions with Pay Less Business Funding LLC dba Pay Less Business Funding and/or its affiliates on either medium. I also here by 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.
Date
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Owner #2 Signature
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Pay Less Business Funding.. and each of its representatives, successors ,assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily, weekly, bi-weekly or monthly 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 Trans Union, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Pay Less Business Funding 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 creditor or financial institution, of any information relating to any of you, to Pay Less Business Funding. And to each of the Recipients, on its own behalf. I am providing my business cell phone and business e-mail address and here by consent to the receipt of correspondence/messages regarding transactions with Pay Less Business Funding LLC dba Pay Less Business Funding and/or its affiliates on either medium. I also here by 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.
Date
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Submit Application
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