Full Name *

Email *

Phone *

Please Complete and Sign the attached application, then Return it with the following Documents

Last Six Months bank Statements (All pages)
Last Four months of Credit Card Processing Statements (only if your Business does a substantial credit card volume)

Bank Statements (Last 6 months) *

Can upload upto 6 files

You also have the option to send documents to the email address or the fax number listed on the application. If you have any questions or like to confirm that we have received your application and statements, please feel free to contact Quick Fi Capital at (877) 354-FUND

Sincerely,

Quick Fi Capital,

Phone: (877) 354-FUND

Fax: (631) 333-920

email: [email protected]

Website: quickficapital.com

Funding Application

Business Legal Name *

Doing Business As *

Legal Entity *

Corporation

LLC

Sole Proprietorship

Federal Tax ID *

Business Phone *

Business Website

Mobile *

Business Fax

Business email *

Business Start Date *

Physical Address

Street Address *

City *

State *

Postal code *

Mailing Address

Full Address

Owner / Principle Information

Principle Owner Name *

% of Ownership Of Principle Owner *

Address Of The Principle Owner *

Phone of Owner *

email of Owner *

Date Of Birth of Owner *

Social Security # of Owner *

2nd Owner Information

Name of 2nd Owner

% Ownership of 2nd Owner

Address Of 2nd Owner

Phone of 2nd Owner

email of 2nd Owner

Date of Birth of 2nd Owner

Social Security # of 2nd Owner

Business Information

Business Description *

State of Incorporation of the Organization *

Renter or Owned *

Open Bankruptcy? *

Rent / Mortgage Amount *

Landlord / Mortgage Company *

Funding Information

Loan Amount or MCA Amount being requested *

What is the Capital being requested for? *

Total Monthly Sales (All Forms of Revenue) *

Gross Annual Sales (Last Year's Tax Return) *

Do you currently have a Loan / Cash Advance? If yes, what is the current outstanding balance *

By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Quick Fi Capital 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 Quick Fi Capital 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 Quick Fi Capital and to each of the Recipients, on its own behalf

Signature - Owner *

Clear

Signature - 2nd Owner

Clear