Application - Dash Funding Source

Company Name*
DBA Name
Federal Tax ID*
Company Type*
Description of Business*
Business Property Rent or Own?*
- Rent
- Own
Rent/Mortgage Paid
FICO Score
Gross Annual Revenue*
Business Start Date Under Current Ownership*
MM slash DD slash YYYY
Business Mailing Address*
Street Address City State ZIP Code
Is your physical address different than your mailing address?
- No
- Yes
Physical Address
Street Address City State ZIP Code
Company Phone Number*
Mobile*
Fax number
Email*
Existing MCA?*
- Yes
- No
If yes, how much?
Which company?
Owner Information (1)
First Name*
Last Name*
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Email*
Home Phone
Cell Phone*
Home Address*
Street Address City State ZIP Code
Percentage Owned*
Is there a second owner?
- No
- Yes
Owner Information (2)
First Name*
Last Name*
Social Security Number*
Date of Birth
MM slash DD slash YYYY
Email*
Home Phone
Cell Phone*
Address*
Street Address City State ZIP Code
Percentage Owned*
Desired Loan Amount*
Desired Loan Term*
Purpose of Loan
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By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Dash Funding Source] (“DFS”) and each of 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 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 DFS to transmit this application form, along 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 DFS and to each of the Recipients, on its own behalf. The applicant certifies that the information on the application is accurate true and correct.
Owner (1) Signature*
Owner (2) Signature

Owner Information (1)

Owner Information (2)