Business Loans Application Step 1 of 4 - Business Info 25% Business DBA Name: Business Name:* Business Phone:*Business Fax:Website: Industry Type:* Annual Gross Revenue*Merchant Type:*Please SelectRetailRestaurantServiceOtherBusiness Start Date* Federal Tax ID:* State of Incorporation:*Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLegal Entity:*Please SelectCorpSole PropLLCPartnershipHiddenMerchant Type: Retail Restaurant Service Other HiddenLegal Entity: Corp Sole Prop LLC Partnership HiddenBusiness Office Location: Store Office Home Other Business Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Business Office Location:*Please SelectStoreOfficeHomeOtherHiddenAnnual Gross Revenue: Rent or Mortgage: Rent Mortgage Mortgage or Rent PaymentLandlord Name: Landlord Phone:HiddenMortgage or Rent Payment $ Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Full Legal Name:* Home Phone:Cell Phone:*% of Ownership:* Title:* Date of Birth:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SSN:* Email:* Any Additional Business Owners?NoYesAdditional Owner DetailsHome Address Owner 2: Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Full Legal Name Owner 2: Home Phone Owner 2:Cell Phone Owner 2:% of Ownership Owner 2: Title Owner 2: Date of Birth Owner 2:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SSN Owner2: Email Owner 2: Amount Requesting:*Use of Capital:* Do you Currently have a Merchant Cash Advance?* Yes No List all Cash Advances with Balances. Daily, Weekly, and Monthly PaymentLenderBalancePayment Add RemoveWhen do you want to get funded? Now 15 Days 30 Days 45 Days Document Upload for ProcessingPlease upload the last 3 months of your business bank statements and the current month to date transactions. Drop files here or Select files Accepted file types: pdf, Max. file size: 500 MB. Consent*By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) certify that you are authorized to apply on behalf of the above listed business and all information provided is true and accurate. You agree to immediately notify VS Global Funding, LLC (“VSGF”) of any material change in financial condition. You authorize VSGF and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about you, 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. You also authorize VSGF to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to VSGF and to each of the Recipients, on its own behalf. Furthermore, you hereby waive and release any claims against VSGF, all Recipients, and any information.providers arising from any act or omission relating to the requesting, receiving or release of the information obtained in connection with this application. Consent approvalDate Owner 1 Signature Owner 1:* Reset signature Signature locked. Reset to sign again Date Owner 2 Signature Owner 2: Reset signature Signature locked. Reset to sign again EmailThis field is for validation purposes and should be left unchanged.