Business Information Company legal name*: Company DBA*: Entity type*: Limited Liability Company Proprietorship C-Corporation S-Corporation General Partnership Limited Liability Partnership Limited Partnership Industry*: Agriculture Automotive Repair Automotive Sales & Gas Service Stations Business Services Communications Construction & Contractors Eating & Drinking Places Educational Services Entertainment Services Finance Food & Beverage Stores Freight Health Services Hotels & Lodging Insurance Legal Services Manufacturing Mining & Natural Resource Extraction Miscellaneous Services Personal Services Real Estate Religious Services Retail Storage Transportation Wholesale Vehicle Rental Business category: None of the below Number of business locations: When did you start your business?*: Business Property Status: : Own Free and Clear Own with Mortgage Lease Time remaining on lease: 1 month or less 6 months or less 1 year or less 2 years or less More than 2 years Landlord name: Landlord phone: Business address 1*: Business address line 2: Business city*: Business ZIP*: Business phone*: Ext: Business email: Business country*: Business state*: Financial Information What do you need the funds for?: Inventory Equipment Expansion/renovation Debt payoff/refinancing Marketing Hiring/payroll Other working capital expense How much capital do you need?: How soon do you need funding?: Immediately Within a week Within a month In more than 1 month What are your average monthly revenues?*: What are your average monthly credit card sales?: Federal tax id: Are there tax liens against your business?*: No Yes Are you on a tax liens payment plan?*: Yes No What is the total balance of all tax liens?: Principal Owner Information First name*: Last name*: Social security number*: Birth date: Contact position*: Owner Manager Accountant CEO CFO COO Non-Owner Ownership percent: Primary email: Mobile phone*: Address*: Address line 2: City*: Country*: State*: ZIP*: Secondary Owner Information (If applicable) First name: Last name: Social security number: Birth date: Contact position: Owner Manager Accountant CEO CFO COO Non-Owner Ownership percent: Email: Mobile phone: Address: Address line 2: City: Country: State: ZIP: By submitting this Rapid Finance Application Form, Business Applicant and each Individual (each a “Signer” and collectively “Signers”) represents, acknowledges and agrees as follows: (i) all information provided to Small Business Financial Solutions, LLC, Rapid Financial Services, LLC and [or] their corporate affiliates (collectively “Rapid Finance”) by Signers is true and complete; (ii) in the event Rapid Finance declines to extend financing to the Business Applicant, Signers authorize Rapid Finance to disclose all information and documents that Rapid Finance may obtain regarding Signers (whether from Signers or third parties) to other persons or entities that are under contract with Rapid Finance for the purpose of providing financing to applicants that Rapid Finance does not provide financing (collectively “Recipients”); and (iii) Signers authorize Rapid Finance and Recipients to: obtain credit and employment information about the Signers; obtain credit reports and make any inquiries Rapid Finance and Recipients consider appropriate in connection with this Application or reviews of the Applicant's account from time to time; disclose account information as required by law. Each Signer acknowledges that additional information may be required in order to render a decision regarding Business Applicant’s account and Signers hereby certify that they have read and understand the terms of this Rapid Finance Application Form. If your application for business credit is denied, you have the right to a written statement of the specific reason for denial. To obtain a statement, please contact Rapid Finance, 4500 East West Highway, 6th Floor, Bethesda, MD 20814, (240) 514-2000, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. You authorize Rapid Finance and prospective third party funding providers to contact you at the numbers you provide (including mobile) during any step of this application, via phone (including automated telephone dialing system, prerecorded, SMS and MMS means) even if you are on a Do Not Call Registry. You are not required to agree to be contacted in this manner to use Rapid Finance's services. Notice If applying for a loan, please note that the Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. This notice may be printed or saved by clicking here: Business Applicant on behalf of I Agree. By clicking “I Agree”, the above party agrees to the terms of this e-Application submission. Individual I Agree. By clicking “I Agree”, the above party agrees to the terms of this e-Application submission. By clicking the “Submit e-Application” button below, you authorize Rapid Finance and prospective third party funding providers to contact you at the numbers you provide (including mobile) during any step of this application, via phone (including automated telephone dialing system, prerecorded, SMS and MMS means) even if you are on a Do Not Call Registry. You are not required to agree to be contacted in this manner to use Rapid Finance's services. *First and last name for principal owner are required! Company legal name is required!