subject_line
MIDDLEMAN CAPITAL LOAN APPLICATION
Business Information
Business type
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Corporation
LLC
Sole proprietorship
Other
Other
Legal Company Name
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Federal Tax ID
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Business Phone
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Business Inception Date
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Industry
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# Of Locations
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Business Location
Address
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Address 2
City
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State
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ZIP
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Do you own or rent?
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Monthly Payment
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Purpose of Loan
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Business expansion
Working Capital
Equipment Purchase
New location
Inventory
Debt consolidation
Debt consolidation
Gross Annual Sales
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Desired Funding Amount
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Business Owner information
Borrower's Full Name (include Jr. or Sr. if applicable)
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Phone
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Email
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Date of Birth (MM/DD/YYYY)
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Marital Status
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Married
Separated
Unmarried (single, divorced, widowed)
Present Address
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Address 2
City
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State
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ZIP
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Ownership %
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you must have at least one item
you must have at least one item
Social Security #
Credit score (Estimate)
The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Middleman Consultants llc. (“Company”) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Company of any change in such information or financial condition, (3) Applicant authorizes Company to disclose all information and documents that Company may obtain including credit reports to other persons or entities (collectively, “Assignees”) that may be involved with or acquire commercial loans or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) and each assignee is authorized to use such information and documents and share such information and documents with other Assignees, in connection with potential Transactions, (4) Each Assignee will rely upon the accuracy and completeness of such information and documents (5) Company, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) Each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.
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Signature
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