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Business Information
Federal Tax ID
*
Business Legal Name
*
Business DBA Name
Type of Business Entity
*
–
Corporation
Limited Liability Partnership
Limited Liability Company
Partnership
Sole Proprietorship
Limited Partnership
Primary Business Structure
*
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Home-based Business
E-commerce
Franchise
None of the above
State of Incorporation
*
–
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Business Date under Current Ownership
*
MM slash DD slash YYYY
Physical Address
*
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DC
DE
DE
FL
GA
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
ZIP Code
Billing Address
*
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DC
DE
DE
FL
GA
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
ZIP Code
Business Owner Cell Phone
*
Business Owner Fax
Business Website Address
Industry Type
*
–
Abortion Clinics
Accountants/ CPA's
Accounting / Tax Prep.
Accounting firms
Adult Entertainment
Adult Entertainment – Examples: Online Dating, Speed dating
Adult Industry
Advertising & Marketing
Agriculture
Airline industry – anything related
Airlines
Amusement / recreation
Animal Hospital/ Veterinarian
Annual Memberships
Antiques / Collectibles
Apparel and Accessories
Appliance Sales
Architecture
Art Galleries
Artists
ATM Services
ATM Vendors
Attorney
Auction
Auction, Appraisal & exchange services
Auto dealers
Automotive
Automotive Customization
Automotive Repair
Auto – restoration
Auto sales (new or used)
Bail Bond Services
Bakery
Bank Lenders
Bar/Pub
Bar & Grill
Beauty Salon / Spa
Beauty Shops
Bed and Breakfasts
Bike Store
Bridal/ Wedding
Brokerage
Building Materials
Businesses in Miami/Dade County, FL
Business Services
Call Center
Cannabis Growers and Sellers
Cannabis – related
Car Services (Uber, Lyft, etc.)
Carwash
Casinos / Gambling
Catering
Celebrities
Cellular Store
Check Cashing
Chiropractor
Churches / Religious Organizations
Class 3 Weapons Dealers
Clothing Store
Clothing Wholesale
Coin dealers
Collection Agency
Commodity – based (precious metals)
Concierge Services (likely within sic code 4724)
Consignment
Construction
Consulting
Consumer Debt Counseling Services
Convenience Store
Convention Related Industries
credit repair
Crime Investigator
Crude petroleum and natural gas extraction
Cryptocurrency
Dating Services
Debt Collection
Dentist
Depository Credit Intermediation
Digital Advertising/Media Groups
Doctor
DOD / Military – Active
Drilling oil and gas wells
Drug paraphernalia
Dry Cleaning
Electronics
Employment agencies
Engineering/Design
Entertainment
Entertainment / circus
Environmental Services
Equipment Rentals
Equipment sales/rentals
Event Planners
Excavation work
Facilities Support Services
Farms / Livestock
Finance
Financial Advisers
Financial Institutions
Financial Services
Financial Transaction & Payment Processing
Firearms, Guns, & Ammunition manufacturer & sales
Firear
Personal Information
Primary Owner
*
First
Last
Social Security Number
*
Date of Birth
*
MM slash DD slash YYYY
Home Phone
*
Home Address
*
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DC
DE
DE
FL
GA
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
ZIP Code
Job Title
*
Landlord Name
Landlord Contact
Email
*
Ownership Percentage
*
Please enter a number from
1
to
100
.
Personal Information – Secondary Owner
Secondary Owner
First
Last
Date of Birth
MM slash DD slash YYYY
SSN
% Ownership
Please enter a number from
1
to
100
.
Home Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DC
DE
DE
FL
GA
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
ZIP Code
Cell Phone
Email
Funding Information
Use of Funds
*
–
Advertising
Buy a business
Debt consolidation
Equipment purchase
Equipment lease
Expansion
Inventory
Startup
Other
Payroll
Real Estate
Remodeling
Taxes
Working Capital
Do you currently have any Judgements/Liens?
*
–
Yes
No
Do you have any open bankruptcies?
*
–
Yes
No
Is your business seasonal?
*
–
Yes
No
Peak Months
*
Do you currently have an existing Working Capital loan?
*
–
Yes
No
Amount Requested
*
Please enter a number greater than or equal to
0
.
Disclaimer
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