apply.freedombizcap.com
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2a01:4f8:252:44c3::
Public Scan
Submitted URL: http://ec2-52-33-3-241.us-west-2.compute.amazonaws.com/x/d?c=29601989&l=8b83a5cf-cfda-4aff-bb54-0336e4d9c109&r=9019c373-bd5d-4b6f-b492-a9d2895f7434
Effective URL: https://apply.freedombizcap.com/
Submission: On February 27 via api from US — Scanned from US
Effective URL: https://apply.freedombizcap.com/
Submission: On February 27 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
POST
<form action="" method="POST" id="big-form" accept-charset="UTF-8" enctype="multipart/form-data" class="has-validation-callback MultiFile-intercepted">
<div style="display: none;">
<input type="text" id="PreventChromeAutocomplete" name="PreventChromeAutocomplete" autocomplete="address-level4">
</div>
<fieldset>
<input type="hidden" id="val-latitude" name="latitude" value="">
<input type="hidden" id="val-longitude" name="longitude" value="">
<div id="arrsec1" class="fields__gr fields__gr_la">
<div class="fields__gr_n">
<h3>
<span class="tt_mob_st">FUNDSHOP</span> FUNDING APPLICATION
</h3>
</div>
<div id="sect-inf" class="form-row" style="display: none;">
<div class="form-group col-md-12">
<label for="input0">Business Inf</label>
<input type="text" class="form-control" id="input0" maxlength="250" name="arrsec1[input0]" placeholder="Business Inf">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="input1">Business Legal Name <span class="text-danger">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="input1" maxlength="250" data-validation="length" data-validation-length="3-250" name="arrsec1[input1]" placeholder="Business Legal Name" value="" required="">
</div>
<div class="form-group col-md-6">
<label for="input2">Doing Business As</label>
<input type="text" autocomplete="nope" class="form-control" id="input2" maxlength="250" data-validation="length" data-validation-length="max250" data-validation-optional="true" name="arrsec1[input2]" value=""
placeholder="Doing Business As">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="input4">Legal Entity <span class="text-danger">*</span></label>
<select id="input4" autocomplete="nope" name="arrsec1[input4]" class="form-control " data-validation="required" required="">
<option disabled="" value="" selected="">Choose...</option>
<option value="Corporation">Corporation</option>
<option value="Limited Liability Company">Limited Liability Company</option>
<option value="Partnership">Partnership</option>
<option value="Sole Proprietorship">Sole Proprietorship</option>
<option value="Other">Other</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="input5">Federal Tax ID <span class="text-danger">*</span></label>
<input type="tel" data-validation="number length" data-validation-length="9" class="form-control" id="input5" name="arrsec1[input5]" maxlength="9" placeholder="Federal Tax ID" autocomplete="nope" value="" required="">
</div>
<div class="form-group col-md-4">
<label for="input6">Business Start Date <span class="text-danger">*</span></label>
<!--<input class="form-control " type="date" name="arrsec1[input6]" id="input6" value="" min="1920-01-01" max="2002-01-01">-->
<input class="form-control" type="text" name="arrsec1[input6]" placeholder="Choose date" autocomplete="nope" data-validation="length" maxlength="50" data-validation-length="1-50" id="input6" value="" required="" max="2023-02-27"
min="1953-02-27">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="input8">Mailing Address <span class="text-danger">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="input8" maxlength="300" data-validation="length" data-validation-length="1-300" name="arrsec1[input8]" placeholder="Mailing Address" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="arrsec1-inputZip_ma">Mailing ZIP Code <span class="text-danger">*</span></label>
<div class="inp__zip">
<input type="tel" autocomplete="nope" onkeyup="getZipFN('arrsec1-inputZip_ma', '#arrsec1-inputCity_ma', '#input8', '#arrsec1-inputState_ma');" data-validation="number length" data-validation-length="5" class="form-control"
id="arrsec1-inputZip_ma" name="arrsec1[inputZip_ma]" maxlength="5" placeholder="ZIP Code" value="" required="">
</div>
<span id="arrsec1-inputZip_ma-error" class="form-error-zip" style="display:none;"></span>
</div>
<div class="form-group col-md-4">
<label for="arrsec1-inputState_ma">Mailing State <span class="text-danger">*</span></label>
<select id="arrsec1-inputState_ma" autocomplete="nope" class="form-control " name="arrsec1[inputState_ma]" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="arrsec1-inputCity_ma">Mailing City <span class="text-danger">*</span></label>
<input type="text" class="form-control" id="arrsec1-inputCity_ma" autocomplete="nope" maxlength="250" data-validation="length" data-validation-length="1-250" name="arrsec1[inputCity_ma]" placeholder="City" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="arrsec1-inputAddr_1">Physical Address <span class="text-danger">*</span></label>
<input type="text" class="form-control" id="arrsec1-inputAddr_1" autocomplete="nope" maxlength="300" data-validation="length" data-validation-length="1-300" name="arrsec1[inputAddr_1]" placeholder="Physical Address" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="arrsec1-inputZip_1">Physical ZIP Code <span class="text-danger">*</span></label>
<div class="inp__zip">
<input type="tel" onkeyup="getZipFN('arrsec1-inputZip_1', '#arrsec1-inputCity_1', '#arrsec1-inputAddr_1', '#arrsec1-inputState_1');" data-validation="number length" data-validation-length="5" autocomplete="nope" class="form-control"
id="arrsec1-inputZip_1" name="arrsec1[inputZip_1]" maxlength="5" placeholder="ZIP Code" value="" required="">
</div>
<span id="arrsec1-inputZip_1-error" class="form-error-zip" style="display:none;"></span>
</div>
<div class="form-group col-md-4">
<label for="arrsec1-inputState_1">Physical State <span class="text-danger">*</span></label>
<select id="arrsec1-inputState_1" autocomplete="nope" class="form-control " name="arrsec1[inputState_1]" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="arrsec1-inputCity_1">Physical City <span class="text-danger">*</span></label>
<input type="text" class="form-control" id="arrsec1-inputCity_1" maxlength="250" data-validation="length" data-validation-length="1-250" name="arrsec1[inputCity_1]" placeholder="City" autocomplete="nope" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="input9">Business Phone <span class="text-danger">*</span></label>
<input class="form-control" data-validation="number length" data-validation-length="10" autocomplete="nope" type="tel" placeholder="Phone" name="arrsec1[input9]" maxlength="10" id="input9" value="" required="">
</div>
<div class="form-group col-md-4">
<label for="input10">Business Email Address <span class="text-danger">*</span></label>
<div class="inp__email">
<input type="email" autocomplete="nope" class="form-control" id="input10" maxlength="100" name="arrsec1[input10]" placeholder="Email" data-validation="email" value="" required="">
</div>
<span id="input10-error" class="form-error-zip" style="display:none;"></span>
</div>
<div class="form-group col-md-4">
<label for="input12">Company Website</label>
<input type="text" autocomplete="nope" class="form-control" data-validation="url length domn" data-validation-optional="true" data-validation-length="max70" name="arrsec1[input12]" id="input12" placeholder="https://www.example.com"
maxlength="70" value="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="input13">Monthly Gross Sales <span class="text-danger">*</span></label>
<select id="input13" autocomplete="nope" name="arrsec1[input13]" class="form-control " title="Monthly Gross Sales" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<option value="$5,000-$15,000">$5,000-$15,000</option>
<option value="$15,000-$30,000">$15,000-$30,000</option>
<option value="$30,000-$60,000">$30,000-$60,000</option>
<option value="$60,000-$100,000">$60,000-$100,000</option>
<option value="$100,000-$200,000">$100,000-$200,000</option>
<option value="$200,000-$350,000">$200,000-$350,000</option>
<option value="$350,000-$500,000">$350,000-$500,000</option>
<option value="$500,000+">$500,000+</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="input14">Amount Requested <span class="text-danger">*</span></label>
<select id="input14" autocomplete="nope" name="arrsec1[input14]" class="form-control " title="Amount Requested" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<option value="$5,000-$15,000">$5,000-$15,000</option>
<option value="$15,000-$30,000">$15,000-$30,000</option>
<option value="$30,000-$60,000">$30,000-$60,000</option>
<option value="$60,000-$100,000">$60,000-$100,000</option>
<option value="$100,000-$200,000">$100,000-$200,000</option>
<option value="$200,000-$350,000">$200,000-$350,000</option>
<option value="$350,000-$500,000">$350,000-$500,000</option>
<option value="$500,000+">$500,000+</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="input-inds-typ">Industry Type <span class="text-danger">*</span></label>
<select id="input-inds-typ" autocomplete="nope" name="arrsec1[indstyp]" class="form-control " title="Amount Requested" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<optgroup label="Agriculture & Forestry/Wildlife">
<option value="Extermination/Pest Control">Extermination/Pest Control</option>
<option value="Farming(Animal Production)">Farming(Animal Production)</option>
<option value="Farming(Crop Production)">Farming(Crop Production)</option>
<option value="Fishing/Hunting">Fishing/Hunting</option>
<option value="Landscape Services">Landscape Services</option>
<option value="Lawn care Services">Lawn care Services</option>
<option value="Other (Agriculture & Forestry/Wildlife)">Other (Agriculture & Forestry/Wildlife)</option>
</optgroup>
<optgroup label="Business & Information">
<option value="Consultant">Consultant</option>
<option value="Employment Office">Employment Office</option>
<option value="Fundraisers">Fundraisers</option>
<option value="Going out of Business Sales">Going out of Business Sales</option>
<option value="Marketing/Advertising">Marketing/Advertising</option>
<option value="Non Profit Organization">Non Profit Organization</option>
<option value="Notary Public">Notary Public</option>
<option value="Online Business">Online Business</option>
<option value="Other (Business & Information)">Other (Business & Information)</option>
<option value="Publishing Services">Publishing Services</option>
<option value="Record Business">Record Business</option>
<option value="Retail Sales">Retail Sales</option>
<option value="Technology Services">Technology Services</option>
<option value="Telemarketing">Telemarketing</option>
<option value="Travel Agency">Travel Agency</option>
<option value="Video Production">Video Production</option>
</optgroup>
<optgroup label="Construction/Utilities/Contracting">
<option value="AC & Heating">AC & Heating</option>
<option value="Architect">Architect</option>
<option value="Building Construction">Building Construction</option>
<option value="Building Inspection">Building Inspection</option>
<option value="Concrete Manufacturing">Concrete Manufacturing</option>
<option value="Contractor">Contractor</option>
<option value="Engineering/Drafting">Engineering/Drafting</option>
<option value="Equipment Rental">Equipment Rental</option>
<option value="Other (Construction/Utilities/Contracting)">Other (Construction/Utilities/Contracting)</option>
<option value="Plumbing">Plumbing</option>
<option value="Remodeling">Remodeling</option>
<option value="Repair/Maintenance">Repair/Maintenance</option>
</optgroup>
<optgroup label="Education">
<option value="Child Care Services">Child Care Services</option>
<option value="College/Universities">College/Universities</option>
<option value="Cosmetology School">Cosmetology School</option>
<option value="Elementary & Secondary Education">Elementary & Secondary Education</option>
<option value="GED Certification">GED Certification</option>
<option value="Other (Education)">Other (Education)</option>
<option value="Private School">Private School</option>
<option value="Real Estate School">Real Estate School</option>
<option value="Technical School">Technical School</option>
<option value="Trade School">Trade School</option>
<option value="Tutoring Services">Tutoring Services</option>
<option value="Vocational School">Vocational School</option>
</optgroup>
<optgroup label="Finance & Insurance">
<option value="Accountant">Accountant</option>
<option value="Auditing">Auditing</option>
<option value="Bank/Credit Union">Bank/Credit Union</option>
<option value="Bookkeeping">Bookkeeping</option>
<option value="Cash Advances">Cash Advances</option>
<option value="Collection Agency">Collection Agency</option>
<option value="Insurance">Insurance</option>
<option value="Investor">Investor</option>
<option value="Other (Finance & Insurance)">Other (Finance & Insurance)</option>
<option value="Pawn Brokers">Pawn Brokers</option>
<option value="Tax Preparation">Tax Preparation</option>
</optgroup>
<optgroup label="Food & Hospitality">
<option value="Alcohol/Tobacco Sales">Alcohol/Tobacco Sales</option>
<option value="Alcoholic Beverage Manufacturing">Alcoholic Beverage Manufacturing</option>
<option value="Bakery">Bakery</option>
<option value="Caterer">Caterer</option>
<option value="Food/Beverage Manufacturing">Food/Beverage Manufacturing</option>
<option value="Grocery/Convenience Store(Gas Station)">Grocery/Convenience Store(Gas Station)</option>
<option value="Grocery/Convenience Store(No Gas Station)">Grocery/Convenience Store(No Gas Station)</option>
<option value="Hotels/Motels(Casino)">Hotels/Motels(Casino)</option>
<option value="Hotels/Motels(No Casino)">Hotels/Motels(No Casino)</option>
<option value="Mobile Food Services">Mobile Food Services</option>
<option value="Other (Food & Hospitality)">Other (Food & Hospitality)</option>
<option value="Restaurant/Bar">Restaurant/Bar</option>
<option value="Specialty Food(Fruit/Vegetables)">Specialty Food(Fruit/Vegetables)</option>
<option value="Specialty Food(Meat)">Specialty Food(Meat)</option>
<option value="Specialty Food(Seafood)">Specialty Food(Seafood)</option>
<option value="Tobacco Product Manufacturing">Tobacco Product Manufacturing</option>
<option value="Truck Stop">Truck Stop</option>
<option value="Vending Machine">Vending Machine</option>
</optgroup>
<optgroup label="Gaming">
<option value="Auctioneer">Auctioneer</option>
<option value="Boxing/Wrestling">Boxing/Wrestling</option>
<option value="Casino/Video Gaming">Casino/Video Gaming</option>
<option value="Other (Gaming)">Other (Gaming)</option>
<option value="Racetrack">Racetrack</option>
<option value="Sports Agent">Sports Agent</option>
</optgroup>
<optgroup label="Health Services">
<option value="Acupuncturist">Acupuncturist</option>
<option value="Athletic Trainer">Athletic Trainer</option>
<option value="Child/Youth Services">Child/Youth Services</option>
<option value="Chiropractic Office">Chiropractic Office</option>
<option value="Dentistry">Dentistry</option>
<option value="Electrolysis">Electrolysis</option>
<option value="Embalmer">Embalmer</option>
<option value="Emergency Medical Services">Emergency Medical Services</option>
<option value="Emergency Medical Transportation">Emergency Medical Transportation</option>
<option value="Hearing Aid Dealers">Hearing Aid Dealers</option>
<option value="Home Health Services">Home Health Services</option>
<option value="Hospital">Hospital</option>
<option value="Massage Therapy">Massage Therapy</option>
<option value="Medical Office">Medical Office</option>
<option value="Mental Health Services">Mental Health Services</option>
<option value="Non Emergency Medical Transportation">Non Emergency Medical Transportation</option>
<option value="Optometry">Optometry</option>
<option value="Other (Health Services)">Other (Health Services)</option>
<option value="Pharmacy">Pharmacy</option>
<option value="Physical Therapy">Physical Therapy</option>
<option value="Physicians Office">Physicians Office</option>
<option value="Radiology">Radiology</option>
<option value="Residential Care Facility">Residential Care Facility</option>
<option value="Speech/Occupational Therapy">Speech/Occupational Therapy</option>
<option value="Substance Abuse Services">Substance Abuse Services</option>
<option value="Veterinary Medicine">Veterinary Medicine</option>
<option value="Vocational Rehabilitation">Vocational Rehabilitation</option>
<option value="Wholesale Drug Distribution">Wholesale Drug Distribution</option>
</optgroup>
<optgroup label="Motor Vehicle">
<option value="Automotive Part Sales">Automotive Part Sales</option>
<option value="Car Wash/Detailing">Car Wash/Detailing</option>
<option value="Motor Vehicle Rental">Motor Vehicle Rental</option>
<option value="Motor Vehicle Repair">Motor Vehicle Repair</option>
<option value="New Motor Vehicle Sales">New Motor Vehicle Sales</option>
<option value="Other (Motor Vehicle)">Other (Motor Vehicle)</option>
<option value="Recreational Vehicle Sales">Recreational Vehicle Sales</option>
<option value="Used Motor Vehicle Sales">Used Motor Vehicle Sales</option>
</optgroup>
<optgroup label="Natural Resources/Environmental">
<option value="Conservation Organizations">Conservation Organizations</option>
<option value="Environmental Health">Environmental Health</option>
<option value="Land Surveying">Land Surveying</option>
<option value="Oil & Gas Distribution">Oil & Gas Distribution</option>
<option value="Oil & Gas Extraction/Production">Oil & Gas Extraction/Production</option>
<option value="Other (Natural Resources/Environmental)">Other (Natural Resources/Environmental)</option>
<option value="Pipeline">Pipeline</option>
<option value="Water Well Drilling">Water Well Drilling</option>
</optgroup>
<optgroup label="Other">
<option value="Other(Business Type Not Listed)">Other(Business Type Not Listed)</option>
</optgroup>
<optgroup label="Personal Services">
<option value="Animal Boarding">Animal Boarding</option>
<option value="Barber Shop">Barber Shop</option>
<option value="Beauty Salon">Beauty Salon</option>
<option value="Cemetery">Cemetery</option>
<option value="Diet Center">Diet Center</option>
<option value="Dry cleaning/Laundry">Dry cleaning/Laundry</option>
<option value="Entertainment/Party Rentals">Entertainment/Party Rentals</option>
<option value="Event Planning">Event Planning</option>
<option value="Fitness Center">Fitness Center</option>
<option value="Florist">Florist</option>
<option value="Funeral Director">Funeral Director</option>
<option value="Janitorial/Cleaning Services">Janitorial/Cleaning Services</option>
<option value="Massage/Day Spa">Massage/Day Spa</option>
<option value="Nail Salon">Nail Salon</option>
<option value="Other (Personal Services)">Other (Personal Services)</option>
<option value="Personal Assistant">Personal Assistant</option>
<option value="Photography">Photography</option>
<option value="Tanning Salon">Tanning Salon</option>
</optgroup>
<optgroup label="Real Estate & Housing">
<option value="Home Inspection">Home Inspection</option>
<option value="Interior Design">Interior Design</option>
<option value="Manufactured Housing">Manufactured Housing</option>
<option value="Mortgage Company">Mortgage Company</option>
<option value="Other (Real Estate & Housing)">Other (Real Estate & Housing)</option>
<option value="Property Management">Property Management</option>
<option value="Real Estate Broker/Agent">Real Estate Broker/Agent</option>
<option value="Warehouse/Storage">Warehouse/Storage</option>
</optgroup>
<optgroup label="Safety/Security & Legal">
<option value="Attorney">Attorney</option>
<option value="Bail Bonds">Bail Bonds</option>
<option value="Court Reporter">Court Reporter</option>
<option value="Drug Screening">Drug Screening</option>
<option value="Locksmith">Locksmith</option>
<option value="Other (Safety/Security & Legal)">Other (Safety/Security & Legal)</option>
<option value="Private Investigator">Private Investigator</option>
<option value="Security Guard">Security Guard</option>
<option value="Security System Services">Security System Services</option>
</optgroup>
<optgroup label="Transportation">
<option value="Air Transportation">Air Transportation</option>
<option value="Boat Services">Boat Services</option>
<option value="Limousine Services">Limousine Services</option>
<option value="Other (Transportation)">Other (Transportation)</option>
<option value="Taxi Services">Taxi Services</option>
<option value="Towing">Towing</option>
<option value="Truck Transportation(Fuel)">Truck Transportation(Fuel)</option>
<option value="Truck Transportation(Non Fuel)">Truck Transportation(Non Fuel)</option>
</optgroup>
</select>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="arrsec1-inputAInf">Additional Information</label>
<textarea class="form-control txt_area_t" id="arrsec1-inputAInf" autocomplete="nope" maxlength="400" data-validation="length" data-validation-optional="true" data-validation-length="1-400" name="arrsec1[inputAInf]"
placeholder="Please provide additional information about the business, money being requested, and current balances, if any." value="" rows="5"></textarea>
</div>
</div>
</div>
<div id="arrsec2" class="fields__gr fields__gr_lb">
<div class="fields__gr_n">
<h3>OWNER INFORMATION</h3>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="input15">Full Name <span class="text-danger">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="input15" data-validation="length" data-validation-length="1-350" maxlength="350" name="arrsec2[input15]" placeholder="Full Name" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="arrsec2-inputAddr_2">Home Address <span class="text-danger">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="arrsec2-inputAddr_2" maxlength="250" data-validation="length" data-validation-length="1-250" name="arrsec2[inputAddr_2]" placeholder="Home Address" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="arrsec2-inputZip_2">Home ZIP Code <span class="text-danger">*</span></label>
<div class="inp__zip">
<input type="tel" autocomplete="nope" onkeyup="getZipFN('arrsec2-inputZip_2', '#arrsec2-inputCity_2', '#arrsec2-inputAddr_2', '#arrsec2-inputState_2');" data-validation="number length" data-validation-length="5" class="form-control"
id="arrsec2-inputZip_2" name="arrsec2[inputZip_2]" maxlength="5" placeholder="ZIP Code" value="" required="">
</div>
<span id="arrsec2-inputZip_2-error" class="form-error-zip" style="display:none;"></span>
</div>
<div class="form-group col-md-4">
<label for="arrsec2-inputState_2">Home State <span class="text-danger">*</span></label>
<select id="arrsec2-inputState_2" class="form-control " name="arrsec2[inputState_2]" autocomplete="nope" data-validation="required" required="">
<option value="" disabled="" selected="">Choose...</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="arrsec2-inputCity_2">Home City <span class="text-danger">*</span></label>
<input type="text" class="form-control" id="arrsec2-inputCity_2" autocomplete="nope" maxlength="250" data-validation="length" data-validation-length="1-250" name="arrsec2[inputCity_2]" placeholder="City" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="input19">Date of Birth <span class="text-danger">*</span></label>
<!--<input class="form-control " type="date" name="arrsec2[input19]" id="input19" value="" min="1930-01-01" max="2002-01-01">-->
<input class="form-control" type="text" name="arrsec2[input19]" placeholder="Choose date" autocomplete="nope" data-validation="length" maxlength="50" data-validation-length="1-50" id="input19" value="" required="" max="2005-02-27">
</div>
<div class="form-group col-md-4">
<label for="input20">Social Security # <span class="text-danger">*</span></label>
<input type="tel" class="form-control" id="input20" data-validation="number length" autocomplete="nope" data-validation-length="9" name="arrsec2[input20]" maxlength="9" placeholder="Please, enter" value="" required="">
</div>
<div class="form-group col-md-4">
<label for="input17">% of Ownership <span class="text-danger">*</span></label>
<input type="tel" class="form-control" data-validation="number" data-validation-allowing="range[1;100]" autocomplete="nope" id="input17" maxlength="3" name="arrsec2[input17]" placeholder="Please, enter" value="" required="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="arrsec2-uphone">Phone <span class="text-danger">*</span></label>
<input class="form-control" data-validation="number length" data-validation-length="10" autocomplete="nope" type="tel" placeholder="Phone" name="arrsec2[uphone1]" maxlength="10" id="arrsec2-uphone" value="" required="">
</div>
<div class="form-group col-md-6">
<label for="arrsec2-uemail">Email Address <span class="text-danger">*</span></label>
<div class="inp__email">
<input type="email" autocomplete="nope" class="form-control" id="arrsec2-uemail" maxlength="100" name="arrsec2[uemail1]" placeholder="Email" data-validation="email" value="" required="">
</div>
<span id="arrsec2-uemail-error" class="form-error-zip" style="display:none;"></span>
</div>
</div>
</div>
<div id="arrsec2-2" class="fields__gr fields__gr_lc">
<details>
<summary><span class="tw__nd_tt">2<span class="min__tt_f">nd</span></span><span class="tw__tt_i">OWNER INFORMATION</span></summary>
<div class="form-row">
<div class="form-group col-md-12">
<label for="input23">Full Name <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="input23" data-validation="length" data-validation-length="max350" maxlength="350" name="arrsec2-2[input23]" placeholder="Full Name" data-validation-optional="true" value="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="arrsec2-2-inputAddr_3">Home Address <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input type="text" autocomplete="nope" class="form-control" id="arrsec2-2-inputAddr_3" maxlength="250" data-validation="length" data-validation-optional="true" data-validation-length="1-250" name="arrsec2-2[inputAddr_3]"
placeholder="Home Address" value="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="arrsec2-2-inputZip_3">Home ZIP Code <span style="display: none;" class="text-danger requ__ff">*</span></label>
<div class="inp__zip">
<input type="tel" autocomplete="nope" onkeyup="getZipFN('arrsec2-2-inputZip_3', '#arrsec2-2-inputCity_3', '#arrsec2-2-inputAddr_3', '#arrsec2-2-inputState_3');" data-validation="number length" data-validation-length="5"
data-validation-optional="true" class="form-control" id="arrsec2-2-inputZip_3" name="arrsec2-2[inputZip_3]" maxlength="5" placeholder="ZIP Code" value="">
</div>
<span id="arrsec2-2-inputZip_3-error" class="form-error-zip" style="display:none;"></span>
</div>
<div class="form-group col-md-4">
<label for="arrsec2-2-inputState_3">Home State <span style="display: none;" class="text-danger requ__ff">*</span></label>
<select id="arrsec2-2-inputState_3" autocomplete="nope" class="form-control " name="arrsec2-2[inputState_3]" data-validation-optional="true">
<option value="" disabled="" selected="">Choose...</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="form-group col-md-4">
<label for="arrsec2-2-inputCity_3">Home City <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input type="text" class="form-control" id="arrsec2-2-inputCity_3" maxlength="250" data-validation="length" data-validation-length="1-250" name="arrsec2-2[inputCity_3]" data-validation-optional="true" placeholder="City" value="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-4">
<label for="input27">Date of Birth <span style="display: none;" class="text-danger requ__ff">*</span></label>
<!--<input class="form-control " type="date" name="arrsec2-2[input27]" id="input27" value="" min="1930-01-01" max="2002-01-01">-->
<input class="form-control" type="text" name="arrsec2-2[input27]" placeholder="Choose date" autocomplete="nope" data-validation="length" maxlength="50" data-validation-optional="true" data-validation-length="1-50" id="input27" value=""
max="2005-02-27">
</div>
<div class="form-group col-md-4">
<label for="input28">Social Security # <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input type="tel" class="form-control" id="input28" data-validation="number length" autocomplete="nope" data-validation-length="9" data-validation-optional="true" name="arrsec2-2[input28]" maxlength="9" placeholder="Please, enter"
value="">
</div>
<div class="form-group col-md-4">
<label for="input25">% of Ownership <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input type="tel" class="form-control" id="input25" data-validation="number" autocomplete="nope" data-validation-allowing="range[1;100]" data-validation-optional="true" maxlength="3" name="arrsec2-2[input25]" placeholder="Please, enter"
value="">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="arrsec2-2-uphone">Phone <span style="display: none;" class="text-danger requ__ff">*</span></label>
<input class="form-control" data-validation="number length" data-validation-length="10" autocomplete="nope" type="tel" data-validation-optional="true" placeholder="Phone" name="arrsec2-2[uphone2]" maxlength="10" id="arrsec2-2-uphone"
value="">
</div>
<div class="form-group col-md-6">
<label for="arrsec2-2-uemail">Email Address <span style="display: none;" class="text-danger requ__ff">*</span></label>
<div class="inp__email">
<input type="email" data-validation-optional="true" autocomplete="nope" class="form-control" id="arrsec2-2-uemail" maxlength="100" name="arrsec2-2[uemail2]" placeholder="Email" data-validation="email" value="">
</div>
<span id="arrsec2-2-uemail-error" class="form-error-zip" style="display:none;"></span>
</div>
</div>
</details>
</div>
<div class="fields__gr fields__gr_ld">
<div class="uploader files" id="fileup">
<div class="file__at">
<div class="file__el">
<span class="btn__file_up btn btn-default btn-file">
<!--Drag & Drop Files here<br><span class="or__slc_f">or</span><br>
max-size=""
max-count=""-->
<label class="btn_slc_f" for="fld_dsd_1">Select file<br>
<div class="MultiFile-wrap" id="fld_dsd_1"><input type="file" class="file__up_inp MultiFile-applied" name="fileup[]" accept="application/pdf" id="fld_dsd_1" multiple="" maxlength="3" data-maxsize="5120" data-maxfile="5120" value="">
</div>
</label>
<br><br>
<span class="file__inf_cnmx file__inf_lgh">Please upload last <b>3</b> months of bank statements for review, along with any other documents that might help.</span><br>
<span class="file__inf_cnmx file__inf_lgh">Files: <b>3</b>,</span>
<span class="file__inf_cnmx file__inf_lgh"> Max size of one file: <b>5 MB</b></span><br>
</span>
<div class="file_up_l" style="display: none;">
<div class="fileList"></div>
<div class="btn_clf"></div>
</div>
</div>
</div>
</div>
<div class="fields__gr_d">
<p>By signing below, each of the above listed business and business owner/officer (individually and collectively, "Applicant") certifies that Applicant is authorized to sign on behalf of the above named company, all information and supporting
documentation submitted with this application is true and accurate, and all such information may be relied upon in evaluating this application. Applicant authorizes B&S Consulting Group, LLC dba Fundshop ("FS") to share this application
and all supporting documentation with any of its representatives, successors, designees, and third party lenders ("Assignees"). Applicant authorizes FS and all Assignees to request, receive and review any consumer of personal, business and
investigative reports and other information about Applicant, 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 for the purpose of evaluating eligibility for commercial credit. Applicant also consents to the release, by any creditor or financial institution, of any information relating to any of
Applicant, to FS and to each of the Assignees, on its own behalf. Furthermore, you hereby waive and release any claims against FS, all Assignees, and any information-providers arising from any act or omission relating to the requesting,
receiving or release of the information obtained in connection with this application.</p>
</div>
<div class="form-row">
<div class="form-group col-md-12">
<label for="input30">Owner Signature <span class="text-danger">*</span></label>
<input type="text" class="form-control has-help-txt" id="input30" data-validation="length confirmation" autocomplete="nope" data-validation-confirm="arrsec2[input15]"
data-validation-help="This field must match the 'Full Name' field in the 'OWNER INFORMATION' section." data-validation-length="1-300" data-validation-error-msg="Input value does not match" maxlength="300" name="arrsec2-2[input30]"
placeholder="Please sign with your Full Name" value="" required="">
</div>
</div>
<div class="form__bi">
<div class="btn__form">
<button id="btn-big-form" type="submit" class="btn btn_form cancel">SUBMIT APPLICATION</button>
</div>
<div class="fomr__sec">
<p><span class="ico__form_sec"></span><span class="ico__txt_sec">Safe, Secure, and Confidential</span></p>
</div>
</div>
</div>
</fieldset>
</form>Text Content
(631) 223-4521
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FUNDSHOP FUNDING APPLICATION
Business Inf
Business Legal Name *
Doing Business As
Legal Entity * Choose... Corporation Limited Liability Company Partnership Sole
Proprietorship Other
Federal Tax ID *
Business Start Date *
Mailing Address *
Mailing ZIP Code *
Mailing State * Choose... Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Mailing City *
Physical Address *
Physical ZIP Code *
Physical State * Choose... Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Physical City *
Business Phone *
Business Email Address *
Company Website
Monthly Gross Sales * Choose... $5,000-$15,000 $15,000-$30,000 $30,000-$60,000
$60,000-$100,000 $100,000-$200,000 $200,000-$350,000 $350,000-$500,000 $500,000+
Amount Requested * Choose... $5,000-$15,000 $15,000-$30,000 $30,000-$60,000
$60,000-$100,000 $100,000-$200,000 $200,000-$350,000 $350,000-$500,000 $500,000+
Industry Type * Choose... Extermination/Pest Control Farming(Animal Production)
Farming(Crop Production) Fishing/Hunting Landscape Services Lawn care Services
Other (Agriculture & Forestry/Wildlife) Consultant Employment Office Fundraisers
Going out of Business Sales Marketing/Advertising Non Profit Organization Notary
Public Online Business Other (Business & Information) Publishing Services Record
Business Retail Sales Technology Services Telemarketing Travel Agency Video
Production AC & Heating Architect Building Construction Building Inspection
Concrete Manufacturing Contractor Engineering/Drafting Equipment Rental Other
(Construction/Utilities/Contracting) Plumbing Remodeling Repair/Maintenance
Child Care Services College/Universities Cosmetology School Elementary &
Secondary Education GED Certification Other (Education) Private School Real
Estate School Technical School Trade School Tutoring Services Vocational School
Accountant Auditing Bank/Credit Union Bookkeeping Cash Advances Collection
Agency Insurance Investor Other (Finance & Insurance) Pawn Brokers Tax
Preparation Alcohol/Tobacco Sales Alcoholic Beverage Manufacturing Bakery
Caterer Food/Beverage Manufacturing Grocery/Convenience Store(Gas Station)
Grocery/Convenience Store(No Gas Station) Hotels/Motels(Casino) Hotels/Motels(No
Casino) Mobile Food Services Other (Food & Hospitality) Restaurant/Bar Specialty
Food(Fruit/Vegetables) Specialty Food(Meat) Specialty Food(Seafood) Tobacco
Product Manufacturing Truck Stop Vending Machine Auctioneer Boxing/Wrestling
Casino/Video Gaming Other (Gaming) Racetrack Sports Agent Acupuncturist Athletic
Trainer Child/Youth Services Chiropractic Office Dentistry Electrolysis Embalmer
Emergency Medical Services Emergency Medical Transportation Hearing Aid Dealers
Home Health Services Hospital Massage Therapy Medical Office Mental Health
Services Non Emergency Medical Transportation Optometry Other (Health Services)
Pharmacy Physical Therapy Physicians Office Radiology Residential Care Facility
Speech/Occupational Therapy Substance Abuse Services Veterinary Medicine
Vocational Rehabilitation Wholesale Drug Distribution Automotive Part Sales Car
Wash/Detailing Motor Vehicle Rental Motor Vehicle Repair New Motor Vehicle Sales
Other (Motor Vehicle) Recreational Vehicle Sales Used Motor Vehicle Sales
Conservation Organizations Environmental Health Land Surveying Oil & Gas
Distribution Oil & Gas Extraction/Production Other (Natural
Resources/Environmental) Pipeline Water Well Drilling Other(Business Type Not
Listed) Animal Boarding Barber Shop Beauty Salon Cemetery Diet Center Dry
cleaning/Laundry Entertainment/Party Rentals Event Planning Fitness Center
Florist Funeral Director Janitorial/Cleaning Services Massage/Day Spa Nail Salon
Other (Personal Services) Personal Assistant Photography Tanning Salon Home
Inspection Interior Design Manufactured Housing Mortgage Company Other (Real
Estate & Housing) Property Management Real Estate Broker/Agent Warehouse/Storage
Attorney Bail Bonds Court Reporter Drug Screening Locksmith Other
(Safety/Security & Legal) Private Investigator Security Guard Security System
Services Air Transportation Boat Services Limousine Services Other
(Transportation) Taxi Services Towing Truck Transportation(Fuel) Truck
Transportation(Non Fuel)
Additional Information
OWNER INFORMATION
Full Name *
Home Address *
Home ZIP Code *
Home State * Choose... Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Home City *
Date of Birth *
Social Security # *
% of Ownership *
Phone *
Email Address *
2ndOWNER INFORMATION
Full Name *
Home Address *
Home ZIP Code *
Home State * Choose... Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Home City *
Date of Birth *
Social Security # *
% of Ownership *
Phone *
Email Address *
Select file
Please upload last 3 months of bank statements for review, along with any other
documents that might help.
Files: 3, Max size of one file: 5 MB
By signing below, each of the above listed business and business owner/officer
(individually and collectively, "Applicant") certifies that Applicant is
authorized to sign on behalf of the above named company, all information and
supporting documentation submitted with this application is true and accurate,
and all such information may be relied upon in evaluating this application.
Applicant authorizes B&S Consulting Group, LLC dba Fundshop ("FS") to share this
application and all supporting documentation with any of its representatives,
successors, designees, and third party lenders ("Assignees"). Applicant
authorizes FS and all Assignees to request, receive and review any consumer of
personal, business and investigative reports and other information about
Applicant, 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
for the purpose of evaluating eligibility for commercial credit. Applicant also
consents to the release, by any creditor or financial institution, of any
information relating to any of Applicant, to FS and to each of the Assignees, on
its own behalf. Furthermore, you hereby waive and release any claims against FS,
all Assignees, and any information-providers arising from any act or omission
relating to the requesting, receiving or release of the information obtained in
connection with this application.
Owner Signature *
SUBMIT APPLICATION
Safe, Secure, and Confidential