Business Funding Application - Shore Funding Solutions

Business Funding Application
Please fill out the form carefully to apply for funding for your business. We will contact you via the supplied contact information on this form.
Name*

First NameLast Name
Company Name*
Email*
example@example.com
Mobile Number*
Alt. Phone Number

Business Start Date*

MonthDayYear
Date
Total Monthly Revenue*
Must have 10k Monthly Revenue or higher
Company Ownership %*
Your stake in ownership
Industry*
Company DBA*
State of Incorporation*
Business Entity Type*
LLC, S Crop, C Corp, etc.
Business Website
(e.g. - www.xyz-corp.com)

Business address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Address & Home Address the same?

YesNo
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Date of birth*

MonthDayYear
Date
Social Security Number*
Federal Tax ID*
Do you have any open MCA or Loan accounts?*

YesNo
Open MCA / Loan Accounts

Please list lender and current balance owed separated by commas (i .e. - Lender A 20k, Lender B 10k)0/100
Bank PDF Files Upload

4 Months of statements (4 files minimum)
Cancelof
Signature*

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By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Shore Funding Solutions] (“SFS”) 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, including consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, providing “written instructions” to SFS under the Fair Credit Reporting Act (FCRA), solely to conduct a prequalification for credit. You also authorize SFS 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 SFS and to each of the Recipients, on its own behalf.
Application date*

MonthDayYear
source
sender_name
full_package_notification_email
example@example.com
utm_source
utm_medium
utm_campaign
utm_term
utm_content
gclid
tracking_code
inquiry_form_id
Should be Empty: