Business Information

Tell us about your business

Company Legal Name *

Business's Doing-Business-As (DBA) Name *

Business Corporate Legal Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Email *

Business Website / URL

Please input your website or facebook URL address.

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Legal Form of Entity & Authorized Signer (Please Check Box and Complete as Indicated):

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Name of Owner: *

(Must Be Signer of Application) Sole Proprietorships file taxes on their IRS 1040

Date of Organization *

For this question, please report the estimated date you registered your business with the IRS and obtained your EIN number.

Number of Partners/Shareholders/Members/Owners in Business: *

Is your primary location / address different than your corporate address? *

Yes
No

Primary Business Phone *

Cell Phone: *

How Long Have You Owned the Establishment? *

Please list both years and months

Number of Employes: *

State of Organization *

FEIN *

Federal Employer Identification Number XX-XXXXXXX

Primary Establishment Address (if Different): *

Address Line 1

Address Line 2

City

State

Zip Code

Number of Additional Locations Under Same Legal Corporate Entity:

Has the Business or Owners Ever Filed For Bankruptcy? *

Yes
No

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Name of Landlord:

Landlord Phone:

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Merchant Sales Information

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Total Annual Credit Card Sales?:

Amount $

Banking Institution for Business Account(s):

Is Your Business Seasonal? *

Yes
No

Total Annual Sales (Cash + CC)?:

Amount $

Has this bank been open for at least 90 days? *

Yes
No

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Cash Needs

(Minimum of $5,000 up to a Maximum of $1,000,000 Based Upon Approved Credit )

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Total Cash Needed:

Weekly Payment You Can Afford?

Date Cash Is Needed:

What does your business do? *

Describe what your business does in one to two sentences.

To whom does your business provide services or products? *

B2B (Business-to-Business)
B2C (Business-to-Consumer)
Both B2B and B2C

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Existing Cash/Financing Providers

How many Cash Providers (aka lenders) does your business owe money too? *

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Name of Cash Provider: *

Do you want to pay them off? *

Yes
No

Please attach the most current statement on your account if you want to pay off this cash provider.

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Amount Funded: *

$

Current Balance: *

$

Rate: *

%

Date Funded: *

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Do you want to pay them off? *

Yes
No

Please attach the most current statement on your account if you want to pay off this cash provider.

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Information on Loan Guarantor (Required)

Legal Name of Guarantor (Primary Owner) *

First

Last

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Owner's Date of Birth *

Driver License Number *

#

Owner's Social Security Number (SSN or ITIN) *

XXX-XX-XXXX

Driver License State and Expiration Date *

i.e. UT 12/2023

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Email *

Cell Phone:

Home Phone:

Address

Address Line 1

Address Line 2

City

State

Zip Code

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How long have you lived at your current residence? *

Please list both years and months

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Required Documentation

(1) Last three month of the bank statements
(2) Most recent merchant credit card processing statement
(3) Driver’s License or Passport
(4) Secondary ID (Passport (if not used as primary), or major credit card
(5) Business Voided Check for all Business accounts tied to the Legal Entity
(6) Current Business tax Return (2021 if not filed then 2020 with tax extension)
(7) If LLC, then please requested the executed operating agreement

Business Bank Statement One (most recent month) *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload the last three months of bank statements separately in one of the following formats: pdf, png, or jpg.

Business Bank Statement Two (month before most recent month) *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload the last three months of bank statements separately in one of the following formats: pdf, png, or jpg.

Business Bank Statement Three (two month before most recent month) *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload the last three months of bank statements separately in one of the following formats: pdf, png, or jpg.

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Upload Owner's Driver License (Front) *