Application - CASH BUOY

Business Information:

Legal Name*

Address*

DBA*

Industry

Time in Business*

Length of Ownership

Number of Locations

Contact Name

Years at Location

Email Address*

Website

Select Business Type:*

Sole Proprietorship
Corporation
Partnership
LLC

Ownership:

First Name, Middle Name, Last Name

Title

Percentage of Ownership of Company

Address

City

State / Province

Zip / Postal Code

Date of Birth

SSN

Cell Phone

*Note: if more than one owner, please click this button: Add an Owner

Lease:

Landlord Name

Landlord Phone

Monthly Rent Amount ($)

Lease Start Date

Lease End Date

Working Capital Request:

Requested Amount ($)*

How do you intend to use these funds*

Do you have a current Cash Advance or Business Loan?*

YES
NO

If Yes,Lender Name

Payment Amount ($)

Original Balance ($)

Current Balance ($)

Use

*Note: if more than one advance or loan, please click this button: Add an advance or loan

Current Business Profile:

Credit Card Processing Company

Referred by (Agent Name and Company)

Average monthly credit card sales ($)*

Average total monthly sales ($)*

Any open state/federal tax liens against the business?*

YES
NO

Any lawsuits or judgements pending against the business owner:*

YES
NO

Signature:

By entering your name below, the applicant and its owners/principals: (1) Certify all information on and documents submitted in connection with this application are true, correct and complete; and (2) authorize Cash Buoy, its agents, partners and lenders to receive credit reports and any other information regarding the applicant and its owners/principals from third parties, in order to verify any information provided on the application.

Type in Your Signature*

Date*

Name

This field is for validation purposes and should be left unchanged.

Have Questions?

Funding Application

Business Information:

Ownership:

Lease:

Working Capital Request:

Current Business Profile:

Signature:

Have Questions?

Funding Application

Business Information:

Ownership:

Lease:

Working Capital Request:

Current Business Profile:

Signature:

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