EmailMeForm
Business Funding Application
Apply@EZCapitalinc.com
(888) 995-8202 (Phone)
*Fill out the application below
*Upload your last 4 business bank statements
*Sign the form by using your mouse or finger
*Once completed click the submit button at the bottom
Legal Business Name:
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DBA Business Name:
Physical Business Address:
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City:
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State:
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Zip:
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Business Phone Number:
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Business E-mail Address:
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Type Of Business Entity:
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Sole Prop, Partnership, LLC, Corp
Start Date Of Ownership:
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Federal Tax ID Number:
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Products / Services Sold:
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Monthly Gross Revenue:
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Purpose Of Funding:
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What do you plan on using the additional working capital for?
Merchant / Owner Information
First Name:
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Last Name:
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Home Address:
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City:
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State:
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Zip:
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SS#
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Date Of Birth MM/DD/YYYY:
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Mobile Phone:
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E-mail Address:
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Tittle:
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% Of Ownership:
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Do you have any Prior / Current Cash Advances? If so with who and what is the balance(s)?
Applicant(s) authorizes EZ Capital Inc. and its assigns, agents, banks or financial institutions to obtain an investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant(s).
First And Last Name:
Signature
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Clear
Date Time
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MM
/
DD
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YYYY
Upload your last four months of business banking statements
Banking statement 1
Banking statement 2
Banking statement 3
Banking statement 4
