Application

VC BIZ LOANS APPLICATION

How much capital does your business need?

What's your annual gross sales?

How long have you been in business?

First Name

Last Name

Business Name

Business Email

Owner Mobile Number

BUSINESS CONTACT INFORMATION

Business Legal Name

DBA

Address

Suite/Fl

City

State or Province

Zip or Postal Code

Business Phone

Website

BUSINESS INFORMATION

Legal Entity - Corporation Sole Proprietor Limited Liability Company (LLC) Limited Liability Partnership (LLP) General Partnership

State or Province of Organization

Federal Tax ID or FBN

Business Start Date (MM/YYYY)

Industry

Description

Type of Product/Service Sold

Was Business Purchased from a Previous Owner?

FINANCIAL INFORMATION

Annual Business Revenue

Does your business have any loans with a daily or weekly repayment schedule or tied to credit card

Receivables

Amount Requested

Purpose of Funds Requested

OWNER / PRINCIPAL INFORMATION (OWNER 1)

First Name

Last Name

Date of Birth

Home Address

Apt/Suite

City

State or Province

Zip or Postal Code

Personal Email

Percent Ownership

Citizenship Status

How many business owners are there?

1 2 3 4

By checking here, you acknowledge that you have read and agree to Vincita Capital’s ESIGN Consent.

By checking here, you acknowledge that you have read and agree to Vincita Capital’s Application Agreement (which authorizes us to obtain information about you and your business, including credit reports, background checks, and bank statements, and submit your financing request to Vincita Capital and third-party funding providers).

* By clicking the Get Funded button above, you consent to receive calls, texts, and e-mails via automated technology or recorded messages to any number or email address you provide regarding offers and my account by or on behalf of Vincita Capital and its affiliates and third-party funding partners. You understand that consent to promotional communications is not required as a condition of any approval or purchase and may be revoked at any time by email or by mail. Message and data rates may apply. You can also apply for business funding by contacting us by phone. All information provided to Vincita Capital is subject to our privacy policy.