Please complete the fields below and either fax or email this application back along with the 4 most recent months of your business credit card processing statements (if applicable) and 4 months of your business bank statements. F: 8772225138 EMAIL: sales@steadycapital.biz FREE QUOTE Phone:877-811-2147 Fax:877-222-5138 Email: sales@steadycapital.biz BUSINESS INFORMATION Legal/Corporate Name: DBA: Physical Address: City: State: Zip: Telephone #: Fax #: Federal Tax ID: Date Business Started: Length of Ownership: Time remaining on Site lease: Type of Entity (check one): Sole Proprietorship Partnership Corporation Type of Business (check all that apply): Retail MO/TO Wholesale Restaurant LLC Rented Mortgaged Monthly Payment: Other Product/Service Sold: Supermarket Other MERCHANT/OWNER INFORMATION Title: Corporate Officer/Owner Name: Home Address: City: SSN: Date of Birth: Ownership %: State: Home #: Estimated Gross Annual Sales: Zip: Cell #: Requested Amount: Is your business for Sale: (Check one) Intended use of Cash: YES / NO Partner Name: PARTNER INFORMATION Title: Ownership %: Home Address: City: State: SSN: Years in Business: Date of Birth: Business Landlord or Business Mortgage Bank: Home #: Zip: Cell #: BUSINESS PROPERTY INFORMATION Contact Name and/or Account #: Phone #: Business Name: BUSINESS TRADE REFERENCES (Please list at least 3 trade suppliers. Please attach any additional references on a separate page.) Contact Name and/or Account #: Phone #: Business Name: Contact Name and/or Account #: Phone #: Business Name: Contact Name and/or Account #: Phone #: Total monthly sales (credit cards, cash, and check) How long at home address? How long at previous address? Do you have any current tax liens, bankruptcies, or foreclosures? If so, are they discharged or on a payment plan? Are you up to date on your current rent or Mortgage? If not, how many months are you behind? Prior/Current Loan (If applicable) If yes, with which company and what is the balance? Applicant authorizes Steady Capital, its assigns, agents, banks or financial institutions to obtain an investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant. Signing this application in no way obligates you or any member of your business to accept the cash advance. This application is merely allowing us to gain an accurate perspective on how much capital you will be pre-approved for. _______________________________________________________ Applicant’s Signature: Please Print & Sign Signature By Hand __________________________________ Date: