Capital Relief Financial, LLC. | Business Application

Contact Information
Select Services:*
Business Legal Name:*
Business DBA (if applicable):
Business Phone:
Mobile Phone:*
Business Fax:
Other Phone:
Website
Email:*
Physical Address:
Address City State ZIP / Postal Code
Mailing Address:*
Address City State ZIP / Postal Code

Business Information
Legal Entity (Select One):*
- Corporation
- LLC
- Partnership
- LP
- LLP
- Sole Proiertership
Business Start Date:*
Federal Tax ID:
Home Based Business?
Open Judgements / Liens?*
Open Bankrupticies?*
State of Inc/LLC:
Business Description:
Industry Type (SIC Code):
Business Rent/Mortgage Information:
Monthly Rent/Lease/Mtg Payment:
Remaining Term for Rent/Lease:
Payment Current?
Landlord/Mortgage Company Contact:
Phone Number:

Funding Information
Amount Requested:*
When Are Funds Needed:*
Desired Use of Funding Proceeds:*
Gross Annual Sales:
Gross Monthly Sales:
Monthly Credit Card Volume:
Current Cash Advance?*
Cash Advance/Loan Balance:
Current Credit Card Processing Company:
Account Number:

Owner/Principal Information
First Name:*
MI:
Last Name:*
Title:*
% Ownership:*
Home Address:*
Address City State ZIP / Postal Code
Home Phone:
Mobile Phone:*
Date of Birth:*
SS#:*
Any Co-Owner?*
Credit Score*

Co-Owner/Principal Information
First Name:*
MI:
Last Name:*
Title:*
% Ownership:*
Home Address:
Address City State ZIP / Postal Code
Home Phone:
Mobile Phone:*
Date of Birth:
SS#:*

Authorization
By signing this form, you agree to Capital Relief Financial, LLC’s Practices and Legal Notice. By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) Capital Relief Financial LLC 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 Capital Relief Financial LLC 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 Capital Relief Financial LLC and to each of the Recipients, on its own behalf. Lastly, you also allow Capital Relief Financial, LLC staff to send you SMS messages in regards to your application submission and file, you can opt out of messaging by replying “Stop” or “Unsubscribe” anytime.
Owner Signature*
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Printed Name:*
Date
Co-Owner Signature*
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Date
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Business Application

Business Application

Contact Information

Business Information

Funding Information

Owner/Principal Information

Co-Owner/Principal Information

Authorization

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