How much Capital is being requested?
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $150,000
$150,001 to $250,000
$250,001 to $350,000
$500,000+
$1,000,000+
Business Info
What is funding being requested for?
Business Legal Name
*
Doing Business As
Business Start Date:
*
Legal Entity:
Corporation
LLC
Sole Proprietor
Federal Tax ID
*
Business Phone Number
*
Address
*
City
*
State
*
Postal code
*
What industry is your business in?
*
Is the business currently operating?
*
Yes
No
How long have you been in business?
*
Purchase Business
Less than 6 months
6-12 Months
1+ years
Do you have a business checking account?
*
Yes
No
Business website URL
Owner / Principal Information
First Name
*
Last Name
*
Phone
*
Email
*
Social Security Number
*
What are your gross monthly sales?
*
Startup
Less than $5,000 per month
$6,000 - $7,999 per month
$8,000 - $9,999 per month
$10,000 - $20,000 per month
$20,000 - $50,000 per month
$50,000 - $100,000 per month
$100,000+ per month
Upload your last 3 months bank statements
*
**Important Note**
You must upload 3 full bank statements with no missing pages or we will not be able to process your application! For example if its September, did you upload August, July and June?
Does you have equity in real estate?
*
Yes
No
If yes, is it residential or commercial?
Residential
Commericial
If YES, please list addresses:
The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Representative including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain including credit reports to other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "Transactions"), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information‐providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant. A copy of this authorization may be accepted as an original. The term “Representative” shall mean any funding source looking to offer, make available, or provide to the Merchant access to loans or merchant cash advances based on such Merchant’s future receivables or sales and/or structured with a periodic repayment feature.
I agree
Owner Full Name
*
Owner Signature
*
Clear