Business Information

Legal Business Name

DBA

Business Address (City, State, Zip)

Business Phone Number

Business Fax Number

Email Address

Business Start Date

Federal Tax ID 

Entity Type

Owner #1

Name

Title

Ownership %

Address

DOB

SSN

Home #

Cell Phone #

Owner #2

Name

Title

Ownership %

Address

DOB

SSN

Home #

Cell Phone #

UPLOAD LAST 3 BANK STATEMENTS

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By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Windgate Capital, Inc.] (“WGC”) 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 or personal, business and investigative reports and other information about you, including credit cardprocessor 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 WGCto transmit this application form, along 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 WGC and to each of the Recipients, on its own behalf. By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Windgate Capital, Inc.] (“WGC”) 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 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 WGC to transmit this application form, along 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 WGCand to each of the Recipients, on its own behalf.

Applicant #1

Applicant #2

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