First Name of Business Owner *

Last Name of Business Owner *

Estimated Personal Credit Score (FICO Range) *

(FICO Range)

Phone *

Home Address *

City

State

Country

Country

Postal code

Legal Business Name (as registered) *

Business Physical Address

Business Mailing Address if Different From Physical Address

Email

Used for secure communication

What type of business do you own? *

How long have you been in business? *

How much funding do you need? *

What do you need funding for? *

Covering immediate expenses

Expanding my business

Purchasing equipment

Building business credit

Starting a business

Would you be interested in business credit building strategies? *

Yes

No

Would you be interested in learning how AI can save you money in your business? *

Yes

No

What is your average monthly revenue *

Business Website *

Do you accept customer payments via credit card *

Yes

No

Do you have a business bank account *

Yes

No

EIN ( Federal Tax ID ) *

Do you currently have any outstanding Merchant Cash Advances (MCAs) or other business loans? *

If yes, can you specify the type of financing, the remaining balance, and the repayment terms? *

What are your current business goals, and how do they relate to revenue growth? *

Please list all individuals or entities with an ownership stake in the business of 25% or more.

Have you established business credit through any of the following agencies? Please select all that apply: *

Bank Statement One *

The most recent 30 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Two *

The most recent 60 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Three *

The most recent 90 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Four *

The most recent 120 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Five *

The most recent 150 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Six *

The most recent 180 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Seven *

The most recent 210 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Bank Statement Eight *

The most recent 240 days

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Middle of the Month Transcript Statement *

The beginning of the month to today.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )All pages, no pen marks.

Equipment Financing Quote (Optional)

THIS IS REQUIRED ONLY IF YOU ARE TYRING TO LEASE A PIECE OF EQUIPMENT INSTEAD OF CASH BEING DEPOSITED IN YOUR ACCOUNT.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

Drivers License (Front) *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Drivers License (Back) *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Voided Check *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Signature *

“Use finger or mouse to sign”

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