CC Form

Business Funding Application

Fill out this super easy form so we can make you an offer.
Owner Name*

First NameLast Name
Email*
Best contact's email
Phone Number*
Best contact's cell phone
Company Name*
Legal Business Name
Monthly Revenue:
Rough average
Looking For:

Working CapitalCredit LineDebt ConsolidationTerm LoanOther
Date Incorporated*
Business Start Date
EIN*
Tax ID
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Incorporation State*
State Incorporated In
Ownership Percentage*
Ownership Percentage
Date of Birth*
Date of Birth
Social Security Number*
Social Security Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Documents:

Business bank statements and any other documents that will help us make an offer
Bank Statements:

Upload your last three month's of bank statements and the current month to-date bank activity and any other documents that will help us make an offer
Cancelof
By signing and faxing or emailing us your application you certify that 1) all information and documents submitted in connection with this application is true, correct, and complete; and 2) you are authorized to apply on behalf of the company whose name appears above; and 3) you authorize LCG, our partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners and principals from third parties, to verify any information provided on the Application.
Name*

First NameLast Name
Signature*

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Business Funding Application

Upload Documents: