CONTACT INFORMATIONBUSINESS INFORMATIONLegal Entity (select one):CorporationHome Base Business?YesNoOpen Judgements?LPYesNoLLCYesNoHome Base Business?State of Inc/LLC:Business Description:FUNDING INFORMATIONAmount Requested:When Are Funds Needed:30 Days60+ DaysASAPCurrent Cash Advance?YesNoDesired Use of Funding Proceeds:Cash Advance/LoanOWNER/PRINCIPAL INFORMATIONFirst Name:MI:Last NameTitle% OwnershipHome Address:City:StateZipFICO Score:Mobile PhoneDate of Birth:SS#CO-OWNER/PRINCIPAL INFORMATIONFirst Name:MI:Last NameTitle% OwnershipHome Address:City:StateZipMobile Phone:Date of Birth:SS#AUTHORIZATIONBy signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) Alliance Capital Group 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 therefore (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 Alliance Capital Group to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all 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 Alliance Capital Group.Owner Signature:Co-Owner Signature:Printed Name:Printed Name:Date:Date:Send Message Funding Application Form
