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Financing Application
Step
1
of
4
25%
Legal Name of Entity
(Required)
Business Inception Date
(Required)
MM slash DD slash YYYY
EIN Number (Tax ID)
(Required)
Example Format: 12-3456789
State of Incorporation
(Required)
Legal Structure of Entity
(Required)
Partnership
Corporation
Limited Liability Company
Sole Proprietor
Business Phone
(Required)
Company Website
(Required)
Please include http:// or https://
Estimated Monthly Revenue
(Required)
Please enter a number greater than or equal to
0
.
Is the Business Home Based?
(Required)
Yes
No
Ownership of Business Location
(Required)
Rented
Owned
Monthly Rent/Mortgage
(Required)
Please enter a number greater than or equal to
0
.
Business Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Owner Info
Owner Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Ownership %
(Required)
Please enter a number from
1
to
100
.
Estimated FICO
(Required)
No personal guarantees, but owner credit is often used for pricing purposes.
Social Security Number
(Required)
Example Format: 123-45-6789
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Mobile Phone
(Required)
Email
(Required)
Use of Funds & Authorization
Requested Funding Amount
(Required)
Please enter a number from
0
to
5000000
.
Use of Funds
(Required)
Please describe how you will use the funds if a transaction is to occur.
Legal Consent
(Required)
I agree to the terms and conditions.
By signing and submitting to us this Application Form, you certify that (i) you are authorized to apply on behalf of the Company, the full legal name of which appears above under the Company Information portion of this Application Form, for a loan or receivables advance for business purposes and (ii) al information you provided on this Application Form and other supporting documents is true and complete and you will notify us of any material changes to such information. You understand and agree that we may disclose al information and documents that we may obtain about Company or you to other persons or entities ("Third Parties"). You understand and agree that we andThird Parties, including our agents and assignees, are authorized to contact third parties to make inquiries in evaluating this Application Form about Company or you (including requesting business and personal credit bureau reports from credit reporting agencies and other sources) or for any update, renewal, extension of creditor other lawful purpose and consent to any such contact or inquiries. Upon your request, we will advise you fi we obtained a credit report and will give you the credit bureau's name and address. Furthermore, you hereby give Babylon Asset Management, LLC permission to contact you at any phone number you provide on or in connection with this application, including via text messages.
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Date
MM slash DD slash YYYY
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