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Company Information  
Legal Name:
(DBA) Doing Business As:
Legal Entity: CorporationGeneral CorporationOther
LLC / LLP : LLCLLP
State of Incorporation:
Tax ID:
Company Type/Industry:
Physical Address (no PO Box):
City:
State:
Zip Code:
Rent or Own: RentOwn
Landlord name:
Landlord phone:
Company Phone:
Business Inception Date:
Does the merchant have a separate

Business bank account?
Has the applicant ever been in Bankruptcy? YesNo
Has the merchant accepted credit card

for the last 6 months?
YesNo
Are any suits/judgments pending? YesNo
   
REQUIRED FOR RECOMMENDED ADVANCE AMOUNT  
Annual business revenue:
Average bank balance:
Monthly credit card volume:
Advance amount requested:
Intended use of funds:
Do you have an outstanding

merchant cash advance?



Yes, it's:

No

   
OWNER 1 INFORMATION  
First name:
Last name:
Email:
Phone:
Cell phone:
SS Number:
Date of birth:
Drivers License Number/State:
Annual Income:
Home address:
City:
State:
Zip Code:
Business Ownership %:
   
OWNER 2 INFORMATION  
First name:
Last name:
Email:
Phone:
Cell phone:
SS Number:
Date of birth:
Drivers License Number/State:
Annual Income:
Home address:
City:
State:
Zip Code:
Business Ownership %:
   
Type this code

in the box below:
captcha
 
 

By submitting your application, you certify that you are authorized to apply on behalf of the company whose full legal name appears above under the Company Information portion of the Loan Application for a business loan from us and that all information you provide within the Loan Application and other supporting documents is true and complete and that you will notify us of material changes to such information. You understand & agree that we and our agents and assignees are authorized to contact third parties to make inquires in evaluating your Loan Application (including requesting business and personal credit bureau reports from credit reporting agencies and other sources) or for any update, renewal, extension of credit bureau name and address. You understand and agree that we may provide credit, and other information from the Loan Application, on the signing individual(s) and the company with third parties who may use the information for any lawful purpose, including for the purpose of offering credit and/or other products and services to the signing individual(s) and/or the company.