Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.General Background: Merchant InformationType of Entity (check one)Type of Entity (check one)Corporationentity 5Limited Liability Partnershipentity 2Limited Liability Companyentity 6Sole Proprietorshipentity 3Partnershipentity 4Limited PartnershipMerchants Legal NameD/B/AFederal ID (or SS# for Sole Proprietorship)Physical Address City, State, ZipBusiness PhoneState of Incorporation/OrganizationBusiness Type; Product/Service SoldDate Business Started(mm/yy)Length of OwnershipWeb AddressBusiness Email *Merchant Ownership Information: Owner No. 1 Percentage (_______% of Ownership)Owner1 NameSocial Security NumberDate of BirthPositionDriver’s License # & StateHome Phone NumberCell Phone #: Personal Email Address *Residence AddressCity, State, ZipMerchant Ownership Information: Owner No. 2 Percentage (_________%) of Ownership (if third owner, please use second application) Owner2 NameSocial Security Number Date of Birth PositionDriver's License # & StateHome Phone NumberCell Phone #Personal Email Address *Residence AddressCity , State, ZipSales & Credit Card ProFessing InformationAvg. Gross Monthly Volume (Cash, Checks, Credit Cards):Credit Card Processor Phone NumberFunding Information Do you have an open loan or merchant cash advance balance YesNoIf yes, company and current balanceHave you used a loan or merchant cash advance program beforeYesNoIf yes, companyIs there an outstanding loan to a previous business ownerYesNoIf yes, monthly payment and termAny state/federal tax liens against ownerYesNoIf yes, detailsHave you or business ever declared bankruptcyYesNoIf yes, detailsAre any suits or judgments pendingYesNoIf yes, detailsBusiness Property InformationOwn/Lease Square Footage (approx.) Lease Start Date Landlord/Mortgage Company Lease TermContact NameMonthly Rent/Mtg Phone Number Ownership balance By signing below, each of the above listed Business Owner(s)/Officer(s)/Principal(s) and Business (individually and collectively, “You”) certify that all information and documents submitted in connection with this Funding Application ("Application") are accurate, true, correct and complete; and that You will immediately notify Bestline Business Funding or any of its representatives, successors, assigns, designees, agents, partners or affiliates ("Recipients") of any change in such information or financial condition. You acknowledge that any false statements may be considered fraud. You acknowledge that the Recipients are relying on the information You provide. You further authorize Bestline Business Funding and each of the Recipients that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions (collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about You, including, but not limited to 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, financial institutions, creditors and other third parties. You authorize Recipients to receive relevant information regarding the commercial lease for the above- referenced premises from our leasing company and/or agent. You also authorize Bestline Business Funding to transmit this Application, along with any of the foregoing information obtained in connection with this Application, to any or all of the Recipients for the foregoing purposes. A photocopy of the Application will be deemed acceptable for release of credit and/or investigatory information.Signature * Clear Signature Date Signature * Clear Signature DateUpload Documents Click or drag files to this area to upload. You can upload up to 6 files. Submit