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Application
Step
1
of
5
20%
Legal Name of Entity
(Required)
Incorporation 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 (LP, LLP, etc)
Corporation (C-Corp or S-Corp)
Limited Liability Company (LLC)
Sole Proprietor (Disregarded Entity)
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/Remote?
(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
.
Est. Credit Score
(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)
Qualification
Requested 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.
Ideal Close Date
(Required)
MM slash DD slash YYYY
What is your deadline to raise funds?
Does the business have any existing debt?
(Required)
Bank Loan or Line of Credit
ABL or Factoring Facility
MCA or Alternative Loans
Other Secured Debt
Please Check All that Apply
When did you receive the MCA/Loan?
(Required)
Last 0-30 Days
31-60 Days Ago
61-90 Days Ago
90+ Days Ago
Although this will not disqualify you, it's extremely important for us to know.
How many MCAs/Loans do you have?
(Required)
1
2
3
4+
Which advisor are you working with?
(Required)
Secure Document Upload
Financial Statements
(Required)
Drop files here or
Select files
Accepted file types: pdf, xlsx, csv, Max. file size: 256 MB, Max. files: 6.
Prior Year and the Year-To-Date Profit & Loss Report and Balance Sheet.
AR Aging and AP Aging Reports
(Required)
Drop files here or
Select files
Accepted file types: pdf, xlsx, csv, jpg, png, Max. file size: 256 MB, Max. files: 2.
Most recent available, ideally updated as of most recent month's end.
Bank Statements
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 256 MB, Max. files: 36.
12 months bank statements for the main Operating Accounts (payroll and savings accounts not necessary at this time).
Debt Schedule
(Required)
Drop files here or
Select files
Accepted file types: xlsx, csv, pdf, doc, docx, Max. file size: 256 MB, Max. files: 1.
Debt schedule listing all creditors, existing balances, payment amounts and frequency, and expected final amortization.
Business Tax Return
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 256 MB.
Most recently filed return, or a Draft of the previous tax-year, even if not filed.
Authorization
Legal Consent
(Required)
I agree to the terms and conditions.
By signing and submitting this Application Form, you certify that you are authorized to submit this Application Form on behalf of the Company (the "Company") and apply for a loan or receivables advance for business purposes. The information you have provided in this Application Form and any supporting documents is true, accurate, and complete, and you agree to promptly notify us of any material changes to that information. You understand and agree that we may disclose the information and documents obtained from you, the Company, or other third parties to other parties ("Third Parties") as necessary to evaluate or process this application or for other lawful purposes. We, and our agents, assignees, and Third Parties, are authorized to contact credit reporting agencies and other relevant sources to obtain business and personal credit reports, as well as any other relevant information, in connection with the evaluation of this application, including for updates, renewals, or extensions of credit. You consent to the procurement of business and personal credit reports from credit reporting agencies and other sources, as well as the inquiry of other third parties, in evaluating this Application Form. Upon your request, we will inform you if a credit report was obtained, including providing the name and contact information of the credit bureau or agency that supplied the report. You also consent to Babylon Asset Management, LLC, its agents, and representatives contacting you at any phone number you provide in this application, including for communications via text messages, for purposes related to the application, loan servicing, or other business communications. By signing below, you acknowledge that you have read, understand, and agree to the terms above and provide your consent for us to proceed with the credit inquiry process.
Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
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