Application for Funding

Please fill the form.

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1
Business Details
Legal Name
DBA Name
Street Address
Suite/ Floor
City, State, Zip
Federal/ State Tax ID
Main Phone Number
Business Start Date
Website
Gross Annual Sales
Entity Type
Lease or Mortage
State of Incorporation
Lease/ Mortage Payment
Business Location Type
Landlorn/ Lender Name
Average Monthly Credit Card Sales
Landlord/ Lender Contact
Amount Requested
Purpose of Financing
Owner Details (First Owner/Officer)
Name
Title
Street Address
City, State, Zip
Phone Number
Percentage of Ownership
Date of Birth
Social Security Number
Owner Details (Second Owner/ Officer- If applicable)
Name
Title
Street Address
City, State, Zip
Phone Number
Percentage of Ownership
Date of Birth
Social Security Number

By signing below, the Merchant and its Owners/Officers identified above (individually, an “Applicant”) each represents, acknowledges and agrees that: 1) all information and documents provided to Lendio, including but not limited to, credit card processor statements, are true, accurate and complete; 2) Applicant will immediately notify Lendio of any change in such information and/or documents or financial condition of the Applicant; 3) Applicant authorizes Lendio to disclose all information and documents that Lendio may obtain, including but not limited to, consumer and/or business credit reports, to other persons or entities (collectively, “Assignees”) that Lendio works with to fulfill its obligations herein, and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential transactions; 4) each Assignee may rely upon the accuracy and completeness of such information and documents; 5) Lendio, Assignees, and each of their representatives, successors, assignees and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification information, or any other information that a Recipient deems necessary, and such authorization shall be considered "written instructions" in accordance with the Fair Credit Reporting Act, as amended ("FCRA") for Lendio or a Recipient to obtain information from an Applicant's personal credit profile form any credit reporting company and to obtain information from the personal credit profile; 6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving, or release of information; and 7) each Owner/Principal represents that he or she is authorized to sign this form on behalf of Merchant.

First Owner/ Officer
Second Owner/ Officer
Name
Name
Signature
Signature
Date
Date
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