BUSINESS INFORMATION

Legal/Corporate Name

DBA

Tax ID/ EIN

Entity Type

Sole Proprietorship
Corporation
LLC
Other
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Type of Business

Product/ Service Offered

Length of Ownership

Date of Incorporation

Phone *

Email *

Address

Street Address

City

State

Postal code

How much are you looking for?

Do you currently have a cash advance?

Yes
No
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If Yes, Which Lender ?

Balance of Cash Advance

BUSINESS OWNER INFORMATION

First Name

Last Name

Date of birth

Owner %

Use of Funds

Social Security Number

Home Address

Home City

Home State

Home Zip Code

Do you have a business partner?

Yes
No
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2nd Owner - First Name

2nd Owner - Last Name

2nd Owner- Social Security Number

2nd Owner - Date of Birth

2nd Owner %

2nd Owner - Home Address

2nd Owner - City

2nd Owner - State

2nd Owner - Zip Code

2nd Owner - Phone

2nd Owner Email

2nd Owner Credit Score

500-550
551-600
601-650
651-700
701-750
751-800
801-850
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By signing below, the Merchant and its owners/principals: (1) certify that informationand documents submitted in connection with this Application are true,correct, and complete; and (2) authorize CHC Capital Group, its agents, partners, and lenders under the Fair Credit Reporting Act to obtain information provided on the Application and/or prevent and report fraudulent transactions.

Signature

Clear

Please print your name

Date

2nd Owner Signature

Clear

2nd Owner - Print Name

2nd Owner Date

Upload Drivers License

Max. file size: 128 MB,

2nd Owner Upload Drivers License

Max. file size: 128 MB,

Upload 3 Bank Statements (CA and NY require 4)

Max. file size: 128 MB, Max. files: 4.

Upload Voided Check

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