Testing PDF - iCapital Funding

Business Information

Business Legal Name

Business DBA Name

Business Phone Number

Business Type

Business Start Date

Federal Tax ID # (EIN)

Business Address

Business City

Business State

Business Zip Code

Do you own multiple businesses?

Yes No

Website URL

Industry

Primary Owner Information

First Name

Last Name

Mobile Number

Date of Birth

Social Security Number

Home Address

Home City

Home State

Home Zip Code

Ownership %

Partner Information (if the primary owner ownership percentage is less than 80%)

First Name

Last Name

Mobile Number

Date of Birth

Social Security Number

Home Address

Home City

Home State

Home Zip Code

Ownership %

Bank Statements

To upload multiple files:

PC - Hold down the CTRL key while selecting your files. MacBook - Hold down the COMMAND key while selecting your files.

Business Bank Statements

The Merchant and Owner(s)/Officer(s) identified above (individually, and "Applicant") each represents, acknowledges and agrees that (1) all the information and documents provided to iCapital Funding ("Representative") including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain including credit reports to the other persons or entities (collectively, "Assignees") 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 therefor (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) Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, "Recipients") are authorized to request and receive and investigative reports, credit reports, statements from creditors or financial institutions, verification information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases and claims against Recipients and any other 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. A copy of this authorization may be accepted as an original.

I agree to the Terms of Service and Privacy Policy.

I swear or affirm that I am the party described above and that all statements in this application, including those pertaining to my identity are true.

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Signature

Signed Date