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Requested Funding Amount:

INTENDED USE OF PROCEEDS

Please explain how you plan to allocate the funds and how the investments will impact your business:

BUSINESS IDENTIFICATION INFORMATION

Business name (DBA):

Business legal name:

Description of business:

Physical business address:

Business phone number:

State of incorporation:

Primary business structure:
FranchiseOther

Business start date under current ownership:

BUSINESS PROFILE

Approximate annual sales:

Number of full time employees:

Gross annual sales (from previous year tax returns):

Do you rent or own your own office space?
OwnRent

Monthly rent or mortgage amount?

EIN/Tax ID number:

OWNER/OFFICER

Full name

Date of birth

Residence address

Cell phone:

Email address:

Social security number:

Annual income:

Ownership percentage:

Owner 2 Click to Add (Optional) Add owner 2

OWNER/OFFICER 2

Full name

Date of birth

Residence address

Cell phone:

Email address:

Social security number:

Annual income:

Ownership percentage:

If you own 50% or more of the business and do not wish to apply for joint credit with any other owner(s), please skip Section IV. Please note that 50% or more of combined ownership percentage is required in order to be eligible for submission.

OTHER CREDIT RELATIONSHIPS

Does the merchant have any open MCA accounts
YesNo

If yes, funding company name

Estimated term

Remittance remaining

Do you have an outstanding business loan
YesNo

If yes, lender name:

Repayment term

Total outstanding balance

Maturity date

AUTHORIZATIONS

By signing below, each of the above listed business owner/officer (individually and collectively, “You”) authorize First Down Funding and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having 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 investigate 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 form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for foregoing purposes. You can also consent to the release, by any creditor or financial institution, of any information relating to any of you, to First Down Funding and to each of the Recipients, on its own behalf.

Owner/Office Signature

Date

Owner/Office Name (please print):