Application

Legal Business Name

DBA (if applicable)

EIN / Tax ID

Type of Business

State Organized In

Years in Business

Time in Business

Industry

Website

Business Phone

Owner 1

Full Name

Title / Ownership %

Home Address

Email Address

Phone Number

Date of Birth

SSN (Full 9 digits)

Owner 2

Full Name

Title / Ownership %

Home Address

Email Address

Phone Number

Date of Birth

SSN (Full 9 digits)

Owner 3

Full Name

Title / Ownership %

Home Address

Email Address

Phone Number

Date of Birth

SSN (Full 9 digits)

Financial Information

Monthly Gross Revenue

Average Monthly Bank Balance

Does your business currently have any advances or loans?

Yes No

If “Yes” → show: Describe Existing Loans

Total Amount in Loans

Requested Funding Amount

Intended Use of Funds

Select all that apply

Currently have an MCA Bankruptcy (past 7 years) Tax Liens

Authorization & Agreement

By signing below, the Applicant(s) certifies that all information contained in this application is true and complete. The Applicant(s) authorizes AltFi Global and its agents, partners, and affiliates to obtain and verify business and personal credit reports, bank statements, tax returns, and other financial information as necessary to evaluate this application. The Applicant(s) further authorizes AltFi Global to share this application and any supporting information with its network of lenders, funders, and financial institutions for the purpose of securing financing. The Applicant(s) acknowledges that AltFi Global is acting solely as an intermediary/broker and not as the lender or provider of credit, and that all final terms, conditions, and approvals are determined by third-party lenders.

Printed Name

Date

Signature