Legal Business Name *

DBA (if different)

Legal Entity *

Date Business Established *

Date Founded

Tax ID / EIN *

Business Classification *

Address *

Street Address

City

State

Country

Country

Postal Code

Phone *

Email *

Website

Property Ownership *

Lease

Own

Years in Control *

Rent / Mortgage Payment *

Landlord / Mortgage Company Name *

Landlord Contact Number *

Filed for Bankruptcy? *

Yes

No

Pending Claims, Judgments, or Tax Liens? *

Yes

No

Owner 1 - Full Name *

First and Last Name

Title *

% of Ownership *

Home Address *

Address (Full)

Home Phone

Cell Phone *

Email Address *

Date of birth *

Driver's License # *

Driver's License State *

Complete this section only if there is a second owner with 20%+ ownership. Otherwise, click Next to continue.

Owner 2 - Full Name

First and Last Name

Owner 2 - Title

Owner 2 - % of Ownership

Owner 2 - Home Address

Address (Full)

Owner 2 - Home Phone

Owner 2 - Cell Phone

Owner 2 - Email Address

Owner 2 - Date of Birth

Owner 2 - Driver's License #

Owner 2 - Driver's License State

Average Monthly Card Sales ($) *

Total Monthly Sales ($) *

Annual Gross Sales ($) *

Desired Funding Amount ($) *

Use of Funds *

Current Loan or Advance Balance? *

Yes

No

If Yes - Balance & Held With

Number of W-2 Employees *

Do You Pay Yourself a W-2 Salary? *

Yes

No

If Yes - Annual Salary Amount ($)

Do You Own or Rent Your Home? *

Yes

No

How Long at Present Address? *

Montly Mortgage / Rent Payment ($) *

Any Outsanding Business Debts? *

Yes

No

List your largest business debts below. If you have no outsanding debts, click NEXT to continue.

Debt 1 - Creditor Name

Debt 1 - Balance ($)

Debt 1 - Monthly Payment ($)

Debt 1 - Credit Limit ($)

Debt 1 - Origination Date

Debt 1 - Refinance with this Loan?

Yes

No

Debt 2 - Creditor Name

Debt 2 - Balance ($)

Debt 2 - Monthly Payment ($)

Debt 2 - Credit Limit ($)

Debt 2- Origination Date

Debt 2 - Refinance with this Loan?

Yes

No

Debt 3 - Creditor Name

Debt 3 - Balance ($)

Debt 3 - Monthly Payment ($)

Debt 3 - Credit Limit ($)

Debt 3- Origination Date

Debt 3 - Refinance with this Loan?

Yes

No

"List your largest vendors or suppliers. Skip if not applicable."

Ref 1 - Company Name

Ref 1 - Contact Name

Ref 1 - Contact Phone

Ref 2 - Company Name

Ref 2 - Contact Name

Ref 2 - Contact Phone

Ref 3 - Company Name

Ref 3 - Contact Name

Ref 3 - Contact Phone

Owner 1 Printed Name *

Co-Owner 2 Printed Name

Authorization & Consent Agreement

By my/our signature on this Application, I/we hereby declare under the penalty of prejury that all information contained in this Application is true, correct and complete. I/we authorize Starting Gate Financial, or it's designee, to verify any of the information from whatever source it deems appropriate, including obtaining and reviewing my/our personal credit profile from a national credit bureau.