Credit Application


Business Legal Name (Merchant):  

Business DBA Name:  

Address:  

City, State, Zip:  

Phone:  

Fax:  

Website:  

Email:  

Legal Entity:  

Federal Tax ID #:  

Industry:  

Business Start Date:

Business Location:  

Products/Services Sold:  

 

Financial Information

How many business do you currently own?  

# of Existing Cash Advance?  

Average Gross Monthly Sales: $

Have you ever had cash advance judgment?  

Is your business a seasonal business? Seasonal Business

 

Have you or any of the current owner/s ever filed for bankruptcy? If so, when? What was the conclusion- discharged or dismissed?

 

Owner Principal Information

Name:  

Home Address:  

Home City, State, Zip:  

Business Address:  

Business City, State, Zip:  

Home Phone:  

Mobile:  

Email:  

% of Ownership:  

Date of Birth:  

SSN#:  

 

2nd Principal Information

Name:  

Home Address:  

Home City, State, Zip:  

Business Address:  

Business City, State, Zip:  

Home Phone:  

Mobile:  

Email:  

% of Ownership:  

Date of Birth:  

SSN#:  

 

By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted with the Application is true, correct and complete; (2) authorize Chrome Capital Funding and its agents, partners and funder to pull credit reports and any criminal or civil background report and any other information regarding the Merchant and principals directly or from third parties, to verify any information provided on the Application.

 

Leave this empty:

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Signature Certificate
Document name: Credit Application
lock iconUnique Document ID: 95d836b19e9ca8dd51ccddd4f321959aa824fc94
Timestamp Audit
March 20, 2019 3:00 am EDTCredit Application Uploaded by Chrome Capital - david@globalsempartners.com IP 72.193.25.122