Funding application Agent Please read and check which applies to you If you are applying for individual credit in your name and are relying on your own income or assets and not the income or assets of another person as the basis of repayment complete Owner Information (1) and omit Owner Information (2). If this is an application for joint credit with another person complete Owner Information (1) and (2). Date Intended Use of Funds: * Company Information Legal Company Name State of Incorporation Federal Tax ID Physical Address (no PO Boxes) City State Zip Code Do you have an outstanding merchant cash advance? If YES how much is it? Company Phone Number Business Inception Date Legal Entity Corporation General Partnership LLC LLP Other Does your business have a separate bank account? YES NO Rent or Own? Rent Own Has your business collected credit cards for the last three months? YES NO Landlord name Company Type/Industry Landlord phone Estimated Flow Overview Your Annual Business Revenue? * Your Average Bank Balance Your Monthly Credit Card Volume Funding Amount Requested Owner Information (1) First Name Email Address * Home Phone Number Cell Phone Number SS Number * Date of Birth * Annual Income Home Address (No PO Boxes) City State Zip Code Business Ownership % Owner Information (2) Name Email Address Home Phone Number Cell Phone Number SS Number Date of Birth Annual Income Home Address (No PO Boxes) City State Zip Code Business Ownership % By signing and submitting your application , you certify that ( i ) you are authorized to apply on behalf of the company whose full legal name appears above under the part of the Company 's funding application a business funding from us and ( ii ) all information you provide on the funding application and other supporting documents is true and complete and that we notify you of material changes to this information. You understand and agree that we and our agents and assigns allowed to contact third parties to consult on the assessment of their funding application ( including requests for business reports and credit personnel offices of the credit reporting agencies and other sources) or for any update, renewal, extension of credit bureau to the undersigned person ( 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 people who sign ( s ) and / or company.
