Online Application

    Legal Business Name*:

    DBA:

    Type of entity*:

    Monthly revenue*:

    Use of funds*:

    Business Address*:

    Email *:

    Business Phone Number *:

    Federal Tax ID *:

    Business Start Date *:

    Business Owner Information

    Name*:

    Phone*:

    FICO Score*:

    Social Security Number*:

    Date of Birth*:

    Home Address *:

    Partner Owning Over 20%

    Name:

    Phone:

    Home Address:

    FICO Score:

    Social Security Number:

    Date of Birth:

    Financial Information

    Do You Have Any Cash Advance Positions:

    Average Credit Card Sales:

    Please Provide: Lender, Funding Date, Current Amount Owed & Original Disbursement Amount This is very important do not leave blank if it applies to you :

    Requested loan amount

    Do you Rent or Own your Business:

    Have you ever filed for Bankruptcy? *:

    Please upload your last 4 months bank statements

    Submission Date*:

    By signing below, each of the above listed business and business owner/officer (individually and collectively, you) authorize Concord Business Solutions and each of its representatives, successors, assigns and designees (Recipients) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, Transactions) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Concord Business Solutions to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Concord Business Solutions and to each of the Recipients, on its own behalf.

    Signature*: