Business Funding Application - Ridgecrest Financial Group

Apply for Funding

Business Legal Name (Required)

Business DBA Name

Address (Required)

Street Address

City

State

ZIP Code

Email (Required)

example@example.com

Phone (Required)

Mobile (Required)

Product / Service Sold (Required)

Partnership (Required)

Corp

Sole Prop

LLC

Business Type (Required)

Store Front

Office

Home

Date Business Started (Required)

EIN (Required)

OWNER/PRINCIPLE INFORMATION

OWNER #1

Name (Required)

Address (Required)

City (Required)

State (Required)

Zip (Required)

Phone (Required)

Email (Required)

example@example.com

% of Ownership (Required)

Date of Birth (Required)

SSN# (Required)

Credit Score

OWNER #2 (IF APPLICABLE)

Name

Address

City

State

Zip

Phone

example@example.com

% of Ownership

Date of Birth

SSN#

Credit Score

FINANCIAL INFORMATION

Amount of Funding Requesting

Purpose of Funds

Existing Advances:

Yes

If yes, what is the remaining balance of the first position

Current Advance with

Payment

LANDLORD OR MORTGAGE INFORMATION

Rent / Mortgage Monthly Amount

Landlord / Mortgage Contact

Landlord / Mortgage Number

Owner #1

By signing below, the Merchant and its owners / principals: (1) certify that all information and documents submitted in connection with this Application is true, correct and complete; and (2) authorize recipient and its affiliates to receive credit reports including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties regarding the Merchant and its owners and principals, to verify any information provided on the Application.

Owner/Principle Signature

Print Name

Date

Owner #2

Owner/Principle Signature

Print Name

Date

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