877-704-0299

Legal Business Name *

DBA Business Name

Business Address *

Entity Type

EIN *

Business Start Date

Owner’s Full Name *

Date of birth *

Personal Address *

Social Security Number

Approximate Credit Score of Business Owner

Email Address *

Phone

Last 4 Months of Business Bank Statements (PDF)

Government-Issued Photo ID

Voided Business Check or Account Ownership Letter

Latest Filed Business Taxes

Authorization to Obtain and Share Information *

By signing below, each of the above-listed businesses and officers/owners (individually and collectively, “you”) authorize Legacy Funding Advisors, LLC and its representatives, successors, assigns, designees, and affiliates (collectively, “Recipients”), in connection with facilitating and submitting applications for business financing—including but not limited to products with daily, weekly, or monthly repayment features, purchases of future receivables (including merchant cash advance transactions), and other business or personal financing options (collectively, “Transactions”)—to obtain consumer, business, and investigative reports and other relevant information about you.This includes but is not limited to credit card processing statements, bank statements, and information from one or more consumer reporting agencies such as TransUnion, Experian, and Equifax, as well as other credit bureaus, banks, creditors, and third parties.You further authorize Legacy Funding Advisors, LLC to transmit this application, along with any information obtained in connection with it, to one or more funding partners, lenders, or other Recipients for the purpose of securing financing options for your business.You also consent to the release of information related to you or your business by any financial institution or creditor to Legacy Funding Advisors, LLC and any of the Recipients acting on its behalf.

Consent to Communications *

By signing below, you consent to receive recurring text messages, emails, and phone calls from Legacy Funding Advisors, LLC and its agents or representatives, delivered using both automated and non-automated technology, for marketing purposes and to provide updates regarding your application, account status, or funding options. Message and data rates may apply. Message frequency will vary. You may reply “STOP” at any time to opt out of text messages. Your information will be handled in accordance with our Privacy Policy and Terms of Use.A copy of this authorization shall be deemed valid as an original and may be accepted whether provided by email, electronic signature, or facsimile.

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