- Edison Juliano
- Muneer Nawab
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MERCHANT INFORMATION
BUSINESS DETAILS
FUNDING REQUEST DETAILS
BUSINESS LOCATION INFORMATION
DOCUMENTS FOR PROCESSING
• Last 3-6 months of business bank statement
• Last 3-6 months of credit card processing statements (if applicable)
• Copy of driver's license(s) for all owners
• FIC / Credit score Rating (Approx)
BROKER DISCLOSURE & CONSENT
We acknowledge that the broker is acting as an intermediary between the merchant and potential funding broker providers. The broker may receive compensation from the funder based on the terms of the funding agreement. The merchant has the right to review and accept or decline any offer presented.
CONFIDENTIALITY NOTICE
All information provided in this application is strictly confidential and will only be used for underwriting and funding purposes. This document does not constitute a binding agreement until a final contract is signed by all parties.
AUTHORIZATION & AGREEMENT
By signing below, I/We:
• Certify that the information provided in this application is true and accurate.
• Authorize the broker and its funding partners to verify business and personal credit history, bank statements, and other financial records.
• Acknowledge that this application does not guarantee approval or funding.
• Agree that the broker and its funding partners are not acting as a fiduciary and that the merchant is responsible for its financial decisions.
• Release the broker and funders from liability for information obtained from credit reporting agencies and third-party verification sources.
By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.