Business Information
Business Name:
*
Please upload your Driver's License/Passport:
*
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Business Owner’s Full Name:
*
First Name
Last Name
Social Security Number
*
Date of birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Business Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Website
Business Industry
*
Please Select
Retail
E-commerce
Health & Wellness
Construction
Transportation
Food Service
Professional Services
Other
If you chose "Other" please specify
Business Details
Business License or Registration
*
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Business EIN
*
Business Type
*
Please Select
Co-operative
Corporation
LLC
Non-profit
Partnership
Sole proprietor
Date Business Was Established:
*
-
Month
-
Day
Year
Date
Is your business currently active and generating revenue?
*
Yes
No
Average Monthly Revenue (last 3 months)
*
Less than $5,000
$5,000–$10,000
$10,000–$25,000
Over $25,000
Do you have a business bank account?
*
Yes
No
Funding Needs
What will the funds be used for? (Select all that apply)
*
Working Capital
Equipment Purchase
Inventory
Marketing/Advertising
Expansion
Debt Consolidation
Other:
If you chose "Other" please specify
Financial & Credit Info
Do you have a minimum credit score of 500?
*
Yes
No
Have you ever filed for bankruptcy?
*
Yes
No
Do you have any existing business loans or funding?
*
Yes
No
If Yes, please specify:
Can you provide the last 3 months of business bank statements if needed?
*
Yes
No
Last 3 Months of Business Bank Statements
*
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Document Upload Section
Voided Business Check or Bank Letter
*
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Most Recent Tax Return (Business or Personal)
*
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Additional Comments
Is there anything else we should know about your business or funding needs?
Authorization
Do you authorize us to run a soft credit pull to explore funding options (won’t affect your credit score)?
*
Yes
No
Submit
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