CC Form

Business Funding Application

Fill out the information below so our underwriters can review and follow up with you immediately with funding options.
Owner Name*

First NameLast Name
Social Security Number*
Social Security Number
Home Address*
Ownership Percentage*
Ownership Percentage
Date of Birth*
Date of Birth
Email*
Best contact's email
Phone Number*
Best contact's cell phone
Company Name*
Legal Business Name
EIN*
Tax ID
Date Incorporated*
Business Start Date
Incorporation State*
State Incorporated In
Looking For:

Working CapitalCredit LineDebt ConsolidationTerm Loan
Monthly Revenue:
Rough average
Minimum 3 months bank statements:

Upload your last three month's of bank statements and the current month to-date bank activity
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*

Powered by Jotform SignClear
Should be Empty:

Business Funding Application