1.Business Information

Legal Business Name

DBA (if applicable)

Mailing Address (if different):

Business Phone

Business Email

Website

Federal Tax ID (EIN)

State of Incorporation/Formation

Date Business Started

Industry / Type of Business:

2.Ownership Information

Owner #1

Full Legal Name

Title:

Ownership%

Date Of Birth

Social Security Number

Home Address

Phone

Owner #2

Full Legal Name

Title

Ownership %

Date of Birth

Social Security Number

Home Address

Phone

3.Business Financial Information

Average Monthly Gross Revenue

Estimated Annual Gross Revenue

Time in Business

Number of Employees:

Current Cash Advances or Business Loans:

Yes

If yes, list provider(s) and balances

Any Prior Bankruptcies(Business or Personal):

Yes

if yes, please explain:

4.Banking Information

Bank Name

Account Type

Checking

Savings

Account Holder Name

Monthly Average Bank Deposits:

How long has this account been open?

5.Requested Funding Information

Requested Funding Amount:

6.Authorization & Certifications

By signing below, Applicant and all Owners:

Certify that all information provided is true, complete, and accurate.
Authorize Lender and its partners to obtain business and personal credit reports, bank statements, and other information necessary to evaluate this application.
Acknowledge that a Merchant Cash Advance is not a loan, but a purchase of future receivables, and repayment is contingent upon business revenue.

Applicant Business Name

Authorized Signer Name

Signature

Clear

signature date

7. Required Documents (Attach with Application)

Last 3–6 months of business bank statements

Copy of valid government-issued photo ID for all owners

Voided business check

Proof of ownership (Articles of Organization/Incorporation, if requested)

Applicant hereby authorizes the release of credit information to our company, or its designee (and any assignee or potential assignee thereof) from any source including credit bureau reporting agencies and applicant’s bank. If Personal information is provided, by signing below, the undersigned individual, provides written instruction to our Gray Marketing Group or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. I hereby represent that all of the information contained in this credit application is true, correct and complete. The signer(s) acknowledge(s) and understand that our company is relying on this information provided herein in deciding to grant or continue credit or to accept a guarantee thereof. Each of the signers represents warrants and certifies that the information provided herein is true, correct and complete and agrees to notify our company immediately of any changes to this information. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract): because all or part of the applicant’s income derives from any public assistance program: or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Opportunity, Washington, DC 20580.

Owner / Principal signature

Clear

Printed Name

Owner/Principal Signature Date