SNF Funding Application

FUNDING APPLICATION
BUSINESS INFORMATION
Business LEGAL Name*
Business DBA Name
Business Street Address*

Business Street Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Business Mailing/Billing Address

Business Mailing/Billing Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Main Contact*
Phone Number*
Email Address*
Website
Federal Tax ID#*
Years in Business*
Years with Current Ownership*
Type of Ownership

Sole ProprietorshipPartnershipCorporationGovernmentLimited Liability (LLC)Tax Exempt Org.Medical CorporationAssociation/Estate/TrustInternational OrganizationOther
If Corporation, what is the state of incorporation?
Type of Business*

Retail StorefrontRestaurantHotel/LodgingServiceMail/Telephone OrderInternetTrade ShowKioskOther
Type of Goods Sold and/or Services Offered*
OWNERSHIP INFORMATION

Owner 1
Name*
Title*
Ownership Percentage*
Street Address*
City, State, Zip Code*
Phone Number*
Social Security Number*
Date of Birth*

MonthDayYear
Date
OWNERSHIP INFORMATION

Owner 2
Name
Title
Ownership Percentage
Street Address
City, State, Zip Code
Phone Number
Social Security Number
Date of Birth

MonthDayYear
Date
FINANCIAL INFORMATION
Average Monthly Total Sales*
Average Monthly Credit Card Sales*
Desired Advance/Funding Amount*
Do you have an OPEN cash advance or dining program?*

YesNo
If Yes,
Company, and Phone #
Have you used a cash advance program before?*

YesNo
If Yes,
Company, and Phone #
Are any suits/judgments/liens pending against the business?*

YesNo
If Yes, provide details
Has the business or any of its owners ever declared bankruptcy?*

YesNo
If Yes:
Discharge Date
State
Chapter
Are any suits/judgments/liens pending against the business?*

YesNo
If Yes, provide details
By signing below, the undersigned certifies that all information provided in this Funding Application is true, correct, and complete. The undersigned authorizes Serra Nova Financial, its representatives, and designated funding partners to obtain consumer and business credit reports, bank statements, processor statements, and other financial information as needed to evaluate this application and provide financing options.

The undersigned further consents to the release of such information by any creditor or financial institution to Serra Nova Financial and its funding partners. Applicant also agrees to receive communications (calls, emails, and text messages) regarding this application at the contact information provided. Message and data rates may apply.
SIGNATURE*

Clear
Title*
Print Name*
Date*

MonthDayYear
Date
Upload Required Documents

Please upload the following documents for review: Last 3–6 months of business bank statements (PDF format preferred), Most recent business tax return (if available), Voided business check (for funding deposits), Owner’s government-issued ID (driver’s license or passport) Note: All files are kept confidential and used solely for underwriting and funding evaluation.
Cancelof
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FUNDING APPLICATION

OWNERSHIP INFORMATION

OWNERSHIP INFORMATION

FINANCIAL INFORMATION