FUNDING APPLICATION
Business Information
Business Legal Name
(Required)
Business DBA Name
Date
MM slash DD slash YYYY
Legal Entity
Federal Tax ID
Industry Type
Phone
Current Credit Card Processor
Business Address
Business Email
Business Website
Owner/Principal Information
Name
SSN
Email
DOB
MM slash DD slash YYYY
% of Ownership
Please enter a number from
1
to
100
.
Mobile
Physical Address
Do You Rent of Own Your Home
Monthly Rent/Mortgage
Second Owner/Principal Information
Name (Co-Borrower)
SSN (Co-Bo)
DOB (Co-Bo)
MM slash DD slash YYYY
Email (Co-Bo)
Mobile (Co-Bo)
% Ownership
Please enter a number from
1
to
99
.
Physical Address (Co-Bo)
Do You Rent or Own Your Home (Co-Bo)
Montly Rent/Mortgage (Co-Bo)
Funding Information
Amount Requested
Credit Score
Total Monthly Revenue Sales
Consent
By signing below, the merchant and its’ owners/principals: (1) certify that all information and documents submitted inconnection with this application is true, correct and complete, (2) authorize Specific Finance, its’ agents, partners, and lenders to receive credit reports, and any other information regarding the merchant and its’ owners, and principals, from third parties, to verify any information provided on the application, and (3) to receive an occasional promotion or offer by email or fax.
Borrower #1 Signature
Borrower #2 Signature
