Application 2018-02-11T03:35:24+00:00

Business Funding Application

Date:

How much money do you need?

Company Information

Legal Company Name:

Business DBA name:

Federal Tax ID:

Physical Address(No. P.O. Boxes):

City:
  State:
  Zip:

Company Phone:

Email:
Business Inception Date:

# Employees:

Funding amount Requested:

Intended Use of Funds:

Does Your Company Has More Than One Bank Account:

Legal Entity:

Company Type / Industry:

State of Incorporation:

Lease / Own:

Monthly Payment:

Landlord Name:

Landlord Phone:

Do you have an Open Loan or Advance Balance with daily or Weekly Payments?

If, yes What is your total balance owed?

Has your business accepted credit cards for at least 3 months?

Credit Card Processor:

Estimated Cash Overflow

Annual business revenue:

Average bank balance:

Last Month's Deposit Total:
# Days with negative balance:

2 Month's ago deposit total:
# Days with Negative balance:

3 Month's ago deposit total:

# Days with Negative Balance:

4 Month's ago deposit total:

# Days with Negative Balance:

Credit Card Processing Overview

Monthly Credit Card Volume:

Average Transaction Amount:

Last Month's CC Sales:
# No of CC Transactions:

2 Month's Ago CC Sales:
# No of CC Transactions:

3 Month's Ago CC Sales:
# No of CC Transactions:

4 Month's Ago CC Sales:
# No of CC Transactions:

Owner Information(1)

First Name:

Last Name:

Email:
Home Phone:

Cell Phone:

Social Security #:

Date of Birth:

Annual Income:

Business Ownership %:

Credit Score:

Title:

Home Address (No P.O. Boxes):

City:

State:

Zip:

Owner Information(2)

First Name:

Last Name:

Email:
Home Phone:

Cell Phone:

Social Security #:

Date of Birth:

Annual Income:

Business Ownership %:

Credit Score:

Title:

Home Address (No P.O. Boxes):

City:

State:

Zip: