Loan Application

Loan application

www.Riversidefunds.com 347-938-6905 Info@riversidefunds.com

Business Funding Application

BUSINESS INFORMATION:

Business Name:

DBA:

Address:

Suite/Floor

City:

State:

Zip code:

Work Phone Number:

Cell Phone Number:

Fax Number:

Website/URL:

Business Start Date:

EIN #:

Type of Entity:

Industry:

You Lease or Own your location?:

Landlord Name & Phone Number:

Rent / Mortgage Amount:

Products/Services Sold

Reason for Funding:

FINANCIALS:

Gross Monthly Sales:

Monthly Credit Card Sales:

Funding Amount Requested:

Do You Have an Open Bankruptcy:

Do You Have an Open Tax Lien:

If so, are you in a payment plan:

Have You Used a Cash Advance Before

If yes, With Who:

If yes, When:

If yes, What is the Current Balance:

OWNER/PRINCIPAL INFORMATION:

Name

First

Last

Co-Owners Name:

First

Last

Address

Co-Owner Address:

City:

State:

Zip code

Co-Owner City:

Co-Owner State:

Co-Owner Zip code

Phone Number:

Email Address:

Co-Owner Phone Number:

Co-Owner Email Address:

Percent of Ownership:

Co-Owner Percent of Ownership

Date of Birth:

Co-Owner Date of Birth:

Social security number:

Co-Owner Social security number:

Signature: I/we affirm my/our identity as the respected individual(s) identified in the above application and I/we declare that the individual(s) who is either a principle of the credit applicant or a personal guarantor of it’s obligations, provides instruction and authority to . Riverside funding financial. it’s designee as well as and in addition to any assignee or potential assignee thereof authorizing review of his/her personal credit report from a national credit bureau. Such authorization shall extend to obtaining a credit report in considering this application and subsequently for the purposes of update, renewal, or extension of such credit or additional credit and for reviewing or collecting the resulting account. Any photo static or facsimile copy of this authorization shall be valid as the original.

Date and Time

Owner Signature:

Clear

Co-Signature:

Clear

Do you agree to the terms and conditions?

No Yes

By signing this document you agree and acknowledgment and authorize Riverside Funding financial. to run your credit report and verify your bank statement that you submitted.

Please Upload your last 4 months of your business bank statement and a copy of your driver license.

Please Upload your Bank statements here:

Maximum file size: 367MB

Please upload your copy of your Driver License front and Back here:

Maximum file size: 367MB

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Loan Application

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