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Step 1 of 2: Owner and Business Info

First Name Last Name Date of Birth Email Contact Number Home Address Home City Home State Home Zip Code How Long You Lived There For? What is your current credit score? Social Security Number Company Name DBA Type of Business Entity How many full time employees do you have? Does anyone other than you own more than 20% of the company? How many percent ownership do you have in the company? Federal Tax ID Business incorporation date Website Avg Monthly Deposits Business Address Business City Business State Business Postal Code Years in Business Annual Business Revenue Do you own or lease the business location? Last Year Net Business Income The Year Before , Last Year Gross Business Revenue The Year Before ;Last Year Net Business Income What is the business gross deposit per month Nature of Business Amount Requested Do You Have a Current Cash Advance? How Many Funders Do You Have?

Type of Loan? Collateral? Bankruptcies in the past? if yes how long ago How soon do you need the money? What will you use the loan for? How did you hear about us? Preferred Callback Time ?

USE OF PROCEEDS

Please specify the amount after selecting one of the choices below. Understanding the use of the fund is essential for effective approval.

Working Capital

Amount:

Inventory

Amount:

Marketing

Amount:

Payroll

Amount:

Refinance Debt

Amount:

Acquisition of Existing Business

Amount:

Equipment

Amount:

Other (Explain)

Explanation: Amount:

USE OF PROCEEDS

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