Application

Primary Owner Information

Name*

First Last

Email*

Cell Number*

Ownership Percentage*

Please enter a number from 1 to 100.

Owner's Home Address*

Street Address City State ZIP Code

SSN*

Date of Birth*

Second Owner Information

Does your business have a second owner with 50% or more ownership?*

Are they able to fill out their information now or at a later date?*

Yes, I can provide their information

No, I can not provide their information now

Your application can still be accepted if you are not able to provide their information.

How would you like to send the shorter application version link to the other owner?*

It will be completed at a later date

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Mobile Number for Application to Second Owner*

Email to Send Application to Second Owner*

Name*

First Last

Email*

Second Owner's Mobile Number*

Ownership Percentage*

Please enter a number from 1 to 100.

Second Owners Home Address*

Street Address City State ZIP Code

SSN*

Date of Birth*

Requested Capital Amount

Requested Amount

Please enter a number from 5000 to 2000000.

Estimated Gross Annual Revenue*

Have you applied for ERC Grant?*

Number of W-2 Employees in 2020:*

Do you currently have open loans?

Yes

**Exclude any relief loans provided that are government based

Number of Open Loans

4 or more

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Bank Statements

Required, but these documents may be submitted via email or fax.

Will you be submitting your bank statements via this online form?*

Bank Statement 1

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 256 MB.

Bank Statement 2