EmailMeForm
Application for Funding
Apply@EZCapitalInc.com
(888) 995-8202 (Phone)
(212) 913-9879 (Fax)
*Fill out the application below
*Upload your last 4 business bank statements
*Sign the form using your mouse
*Submit the form
Requested Funding Amount
Purpose of the funds:
Legal Business Name:
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DBA:
Business Address:
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City: State: Zip / Postal Code:
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Email:
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Website:
Phone
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Fax
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Business start date under current ownership
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MM
/
DD
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YYYY
Type Of Business
Please select
Retail
Wholesale
Restaurant
Transportaoin
Service
Other
Type Of Entity:
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Please select
Sole Proprietorship
Partnership
LLC
Corporation
Other
Products / Services Sold:
Federal Tax ID #:
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What is your average monthly gross revenue?
Have you ever filed bankruptcy?
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If yes, when?
Do you have any open cash advances or business loans?
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Please Select
No
Yes
If yes, with what company or companies?
What is your estimated current balance(s)?
Corporate Office / Owner Name:
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Title:
Ownership %:
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Home Address:
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City: State: Zip / Postal Code:
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SSN#:
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Date of Birth:
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Cell #:
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E Mail Address:
What would you say your credit score is?
Below 500
500-550
550-600
600-650
650-700
700 Plus
(Partner) Corporate Officer / Owner Name:
Title:
Ownership %:
Home Address:
City: State: Zip / Postal Code:
SSN#:
Date Of Birth:
Cell Phone:
E Mail Address:
What would you say your credit score is?
Below 500
500-550
550-600
600-650
650-700
700 Plus
Do you rent or have a mortgage for the business location?
What is the monthly rent or mortgage for the business?
If you are renting how much time is left on your lease?
Business Land Lord or Mortgage Bank contact name:
Contact Phone Number:
Upload your last 4 months of business banking statements
Bank Statement One:
Bank Statement Two:
Bank Statement Three:
Bank Statement Four:
By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize EZ Capital Inc. 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. You also authorize EZ 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 EZ Capital and to each of the Recipients, on its own behalf.
Signature
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Clear
Date Time
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MM
/
DD
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YYYY
