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Intake Form

BUSINESS INFORMATION

Legal Company Name *

Doing Business As

TAX ID/EIN

Industry *

Business Start Date *

Financing Amount

Company Email Address *

Ownership Percentage *

Business Phone Number *

Do You Process Credit Cards?

Company Address Line 1 *

Company Address Line 2

City *

State *

ZIP Code *

Website URL

OWNER INFORMATION

Full Name *

Social Security Number *

Date of Birth *

Phone Number *

Email Address *

Address Line 1 *

Address Line 2

City *

State *

ZIP Code *

SECOND OWNER INFORMATION

If Applicable*

Full Name

Social Security Number0 / 10

Date of Birth

Ownership Percentage

Phone Number

Email Address

Address Line 1

Address Line 2

City

State

ZIP Code

E-Signature *

Start signing your signature here

Note: By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize (AP Capital Group, LLC) 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 and/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 (AP Capital Group, LLC) to transmit this application form, 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 (AP Capital Group, LLC) and to each of the Recipients, on its own behalf. I am providing my cellphone number and hereby consent to the receipt of text messages knowing that msg. and data rates may apply. I understand that consent to receive texts is not a condition of approval. I can expect approx. 10 msgs/month. I/We certify that all the information contained herein is complete, true and accurate.

CONTACT US

Address

80 Broad St New York, NY 10004

Call Us

+1 (646) 493-8228

Email Address

info@apcapitalus.com

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