Funding Application

Personal Information

First Name:
Last Name:
Date of Birth:
Personal Number:
Personal Email:
Percent Owned:
How many other owners?:

Business Information

Business Legal Name:
Legal Entities:
Business Start Date:
Business Address:
Business City:
Business State:
Business Zip:
Business Number:
Business Email:
Is the business seasonal?:
Description of business:

Financial Information

Gross Annual Sales:
Recent Month Business Deposits:
Do you have a current loan or business advance?:
Current Balance:
Pmt. Amount:
Pmt. Frequency:
Months Remaining:
Any Pending Litigation? Claims? Judgements?:
Are you contemplating Bankruptcy, Reorganization, or Sale of the Business?:

Disclaimer: By signing below, each of the above listed business and business owners/officers (individually and collectively, "you") authorize The Fundworks, LLC and each of its representatives, successors, assigns, designees, and third-party funding partners which includes lenders and other finance providers with whom The Fundworks, LLC has, or may in the future enter into, commercial-brokerage-financing relationships ("Recipients"): (1) to obtain consumer or personal, business and investigative 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, banks, creditors and other third parties; (2) to obtain the release, by any creditor or financial institution, of any information relating to any of you, to any Recipients; (3) to transmit this application to form, along with any of the foregoing information obtained in connection with this application, to any or all Recipients for the foregoing purposes; and (4) to contact you via e-mail, call and/or text message at the email address and/or phone number provided above, or at any e-mail address and/or phone number reasonably identified as belonging to you, including wireless numbers (if applicable), using an automated telephone dialing system or other similar system with respect to this application, future-related commercial-financing opportunities and/or other lawful telemarking purposes (the consents provided in this subsection (4), the "Communications Consent"), that no purchase of goods or services is contingent upon said Communications Consent, and that telephone calls to and from you and any Recipient may be recorded. You certify that all information and documents submitted in connection with this application are true, correct and complete.

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Signature Certificate
Document name: Application
lock iconUnique Document ID: da4a8868453039c273959f93efd3193ac70af976
Timestamp Audit
October 6, 2023 10:10 am EDTApplication Uploaded by Fundworks Admin - IP
October 9, 2023 11:35 am EDTBabylon Confirmation - added by Fundworks Admin - as a CC'd Recipient Ip:
October 18, 2023 9:48 am EDTBabylon Confirmation - added by Fundworks Admin - as a CC'd Recipient Ip:
October 30, 2023 8:52 pm EDTBabylon Confirmation - added by Fundworks Admin - as a CC'd Recipient Ip: