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Business Loan Online Application

Fill in the name and email for each signing role listed below. Signers will receive an email inviting them to sign this document.

Please enter your name and email to begin the signing process.

Your Full Name:

Your Email:

Your Phone Number:

Business DBA Name:

Please read the Electronic Record and Signature Disclosure

Business Information

Business DBA Name:

Corporation Name:

Tax ID (EIN):

Entity Type:

Business Address:

Business Phone:

Email:

Gross Annual Deposit Volume:

Start Date:

Owner Information

Owner Full Name:

S.S Number:

D.O.B:

% of Ownership:

Phone Number:

Email:

Home Address:

FICO:

Co-Applicant Information if Applicable

Co-Owner Full Name:

S.S Number:

D.O.B:

% of Ownership:

Phone Number:

Email:

FICO:

Home Address:

Authorization

By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Infusion Capital (IC) 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 Synergy 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 Synergy and to each of the Recipients, on its own behalf

Signature:

Title:

Date:

Signature:

Title:

Date:

Loan amount you’re requesting:

(include the amount to be paid off from your existing loan/advance) ($):

Current Merchant Cash Advances

Please list all current loans you have outstanding with estimated balances, If Applicable**

Do you have a cash advance now?

1st Position Company:

Balance:

Payment Amount:

2nd Position Company:

Balance:

Payment Amount:

3rd Position Company:

Balance:

Payment Amount:

Open Judgements?

If yes, how much?

Bankruptcy in the last 12 months?

If yes, date of discharge?

Attachments

Please submit the 6 to 8 most recent business bank statements

Are you submitting any Bank Statements?

August, 2023

Select File

Required

Upload Successful!

September, 2023

Select File

Required

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October, 2023

Select File

Required

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November, 2023

Select File

Required

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December, 2023 To Date

Select File

Required

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