Capital & Consumer Funding Application

Please fill out the following form below and be sure to attach the necessary documents to complete your Application. If you have any questions please reach out to info@thebusinessambassador.com. Please note you will need the following documents prepared to complete your application: 3 Banking Statements, 3 Payment Processing Statements, Voided Check, Article of Incorporation, EIN Letter from IRS, Sample Contract(s), Payment Authorization Form, and Refund Policy.

Full Name

First Name

Last Name

Application of Interest

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Business Address

(if different than above; enter NA for None)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone No.

(###)

###

####

Business Email

Business Type

Legal Name of Business

DBA or Trade Name

EIN Number

SSN Number

Business Website

http://

Does your business currently accept recurring payments?

Yes

Account Type

Name on Account

Account Number

Routing Number

Smallest Transaction Size

Largest Transaction Size

Average Transaction Size

Current Monthly Revenue

Projected Monthly Revenue (with Funding)

Business Industry

What do you sell?

Please list or describe your products or services here...

Comments

Did someone refer you? If yes, enter their name.