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Funding app

COMPANY INFORMATION
Legal Name:

DBA

Industry Type:

State of Creation:

Legal Entity Type:

Federal Tax ID:

Business Phone:

Business Email:

Physical Address:

City, State:

Zip Code:

BUSINESS FINANCIAL INFORMATION

Average Monthly Sales $

Time in Business

Owner Information

Full Name

Date of Birth

Business Ownership %

Social Security Number

Do you have assets that could unlock immediate liquidity?
If so, list them below and a funding specialist will contact you to structure the best financing solution.

Home Address

City, State, Zip Code

Print Name

Signature

Last 3 Business Bank Statements

By signing above, each of the above listed business and business owner/officer (individually and

collectively, “you”) authorize Lahrichi Capital, its representatives, successors, assigns and

designees (“Recipients”) 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”), to

obtain consumer and/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. You also authorize Lahrichi Capital to transmit this

application form, with any of the foregoing information obtained in connection with this application,

to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any

creditor or financial institution, of any information relating to any of you, to Lahrichi Capital and to

each of the Recipients, on their own behalf. I am providing my cellphone number and hereby

consent to the receipt of text messages knowing that message and data rates may apply. I

understand that consent to receive texts is not a condition of approval. I can expect approximately

10 messages per month. I/We certify that all the information contained herein is complete, true and

accurate.