Application

Business Funding Application

Complete the numbered sections and submit the required authorization package directly to the configured intake webhook.

Company

Legal Company Name *Entity Type *Federal Tax ID *State of Incorporation *Business Inception Date *Business AddressBusiness CityBusiness StateBusiness ZIP

Primary Owner

First Name *Last Name *EmailSSN *Date of Birth *Cell PhoneAddressCityStateZIPOwnership Percentage *

Second Owner Yes/No *

Additional Owner

No second owner selected. The submitted value will be null.

Documents

Required Bank Statements *Upload one or more PDF, JPG, JPEG, or PNG files. 10 MB maximum per file.Required Business Tax Return *Upload one or more PDF files. 10 MB maximum per file.

Authorization

The above hereby authorizes Zuricata Financial, on a on exclusive basis, to seek financial transactions on its behalf from the date stated herein, and otherwise from time to time until any and all loans and/or revenue based financings are repaid in full and the relationship with the merchant is completed, including but not limited to for any renewal or for any purpose relating thereto.

By signing below, the Merchant and its owners/principals: (1) certify that all information and documents submitted in connection with this application are true, correct, and complete; and (2) authorize Zuricata Financial and its assignees/designees to obtain credit reports and any other information regarding the Merchant and its owners and principals to verify the information provided on the application.

I accept the disclosure *

Owner 1 signature

PNG signature captured from mouse or touch.