Elevation Solution Services, LLC

Funding Information Form

First Name *

Last Name *

Phone *

Email *

Address

Street Address *

City *

State *

Country

Postal code *

Do you Rent or Own (current address) *

Rent

Own

Other

How long at current address? *

Are you a US citizen or Permanent Resident? *

Yes

No

Date of birth *

What is your annual income? (Enter number below) *

What is your Employment status? *

Employed

Self-Employed

Unemployed

What is your current job title? (From employer NOT business) *

Mother's maiden name *

Signature *

Clear

Please upload a copy of your Driver's License

Please upload a copy of your Social Security Card

Please upload a copy of your Transunion Report

Please upload a copy of your Experian Credit Report

Please upload a copy of your Equifax Credit Report

Do you currently have a business? *

Yes (continue filling out the form)

No (Scroll down to Start a New Business)

Business Name?

Business Address

What percentage of ownership do you have?

100%

99%-51%

50% or less

Business Email?

Business Phone Number

Business Formation State?

Business Formation Date?

What Business bank accounts do you currently have?

What Business products do you have? (List all business credit card, lines of credit, loans, etc...)

Business Yearly Income?

Are you a W2 EMPLOYEE of your business?

Yes

No

What is your Business EIN?

What is your DUNS Number?

Have you filed taxes in the last 2 years?

Yes

No

What was your gross income reported for personal and business?

Do you have proof of income? Paystubs, Business bank accounts, taxes, etc.? Which one?

Please upload a copy of your Articles of Incorporation or Articles of Organization

Please upload a copy of your IRS EIN Letter

START A NEW BUSINESS

Yes

No

Answer the next few questions if you are interested in starting a business.

What kind of business do you want to have?

Retail

Service

E-Commerce

Other

What do you want to call your business? List 3 choices

Will you have a partner?

Yes

No

In what state do you want to form the business?

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