Elev8HER Capital Business Funding Application

1

Borrower Full Name* This field is required.Enter the name of primary business owner and borrower/applicant

First Name

Last Name

2

Email* This field is required.Enter your primary business email

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

3

Phone Number* This field is required.Enter your primary phone number

Please enter a valid phone number.

4

Preferred Communication* This field is required.Select your preferred method of contact

By Email

By Text

By Phone

Other

5

Credit Score * This field is required.Please select the range of your credit score

Example: Poor: 500 - 580

6

Co-Borrower* This field is required.If Yes, add Borrower Information Below

Yes, add borrower information

No

7

Co-Borrower Full Name Enter the name of the co-borrower/applicant

First Name

Last Name

8

Co-Borrower Phone NumberEnter the primary phone number

Please enter a valid phone number.

9

Co-Borrower EmailEnter your primary email

example@example.com

10

Co-Borrower Preferred CommunicationSelect your preferred method of contact

By Email

By Text

By Phone

Other

11

Co-Borrower Credit Score Please select the range of your credit score

Example: Poor: 500 - 580

12

Business Name* This field is required.Enter the name of the entity seeking funding

Example: Jane Doe LLC

13

Entity Type * This field is required.Select the entity structure of the business seeking funding

Example: Jane Doe LLC

14

Entity State Formation * This field is required.Select the State is your business registered in

Example: Texas

15

Business Website (If Applicable)Enter the website for the business seeking funding

Example: www.myonlinebusiness.com

16

Business Industry* This field is required.Select the industry of the business seeking funding

Example: Health & Medical Clinics

17

Time in Business* This field is required.Select the time this entity has been in business

Example: 1 - 3 years

18

Business Monthly Revenue* This field is required.Select the range the business generates in monthly revenue

Example: $10K-$25K

19

Funding Amount Being Requested* This field is required.Select the loan amount you look to acquire

Example: $10K-$25K

20

Funding Purpose* This field is required.Please select the reason for seeking funding

Example: Working Capital

21

Please give reference of any two people whom you feel could benefit from Elev8HER Capital:Example: Jane Doe, City/State, Phone Number

Full Name

Address

Contact Number

1

2

1

2

Full Name

Address

Contact Number

Full Name

Address

Contact Number

22

Electronic Signature* This field is required.Sign Below to Proceed

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23

Terms and Conditions* This field is required.By submitting this form, I acknowledge that I am applying for business funding through Elev8HER Capital and understand that my information will be shared with a third-party lender. I agree to the Terms & Conditions and understand that approval is based on financial eligibility, entity verification, ability to pay the lender back, and lender discretion.