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Let's start by getting some information about you, the business owner.
Business Name (DBA)
*
*
Indicates required field
Business Legal Name
*
As shown on your income tax return
Primary Owner Name (1)
*
First
Last
Primary Owner Email (1)
*
Primary Owner Name (2)
*
First
Last
Primary Owner Email (2)
*
Business Phone Number
*
Business Address
*
Line 1
Line 2
City
State
Zip Code
Country
Gross Monthly Receivables
*
Below $5,000.00
$5,000.00 - $10,000.00
$10,000.00 - $25,000.00
Above $25,000.00
Business Start Date
*
Owner(s) Credit Score
*
Estimated. As of last time checked.
Accept Credit Card Payments
*
Yes
No
Business Property Information
*
Lease
Own
Home Based Business
Primary Use of Funds
*
Pleasee explain what you intend to use the funding for. Paying bills, hiring employees, starting a new campaign or buying a new location. Let us know here
I agree to receiving marketing and promotional materials
*
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Services
Payment Processing
Business Funding
Payroll Solutions
Partner
Newsletter
Consultation
Contact
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