Credit Application Form Business Owner Information "*" indicates required fields Step 1 of 3 33% BUSINESS INFORMATIONBusiness Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code DBA (doing business as) Phone*Email* Fed Tax ID # Industry Type Business Start Date MM slash DD slash YYYY What do you need to funds forBusiness ExpansionWorking CapitalInventory PurchaseEquipment or MachineryDebt ConsolidationMarketing and AdvertisingOtherHow much are you looking to borrow$5,000 - $10,000$10,001 - $25,000$25,001 - $50,000$50,001 - $100,000100,001 and aboveIndustry Type Sole Prop LLC Corp Other PRIMARY OWNER INFORMATIONName First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneHome PhoneDate of Birth MM slash DD slash YYYY Social Security Estimated Fico Score Ownership %100 %50 %Is there another owner Yes No SECONDARY OWNER INFORMATIONName First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneHome PhoneDate of Birth MM slash DD slash YYYY Social Security # Estimated Fico ScoreOwnership %100 %50 % FINANCIAL INFORMATIONAVG. MONTHLY SALESMONTHLY GROSS SALES:BALANCEIS YOUR BUSINESS HOME BASED? Yes No DO YOU HAVE AN OPEN BANKRUPCY? Yes No Please upload your last 3 bank statementsOnly .pdf,.jpg files acceptedBank Statement 1*Accepted file types: pdf, jpg, Max. file size: 64 MB.Bank Statement 2*Max. file size: 64 MB.Bank Statement 3*Max. file size: 64 MB.Consent* AUTHORIZATIONBy signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Aspira Capital 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 Aspira Capital 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 authorize Aspira Capital 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 Aspira Capital and to each of the Recipients, on its own behalf." In Addition, you expressly consent to receiving marketing and other calls and messages, to land line, wireless or similar devices, including auto dialed and pre-recorded message calls, and SMS messages (including text messages) from Recipients, at telephone numbers that you have provided. Message and data rates may apply. Your consent to receive marketing calls is not required for your application; if you do not consent do not provide cell phone number.Owner 1 SignatureDate MM slash DD slash YYYY Owner 2 SignatureDate MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Get Funded Today
