Information Form

Please take a minute to complete this form. This will not affect your credit score.

Business Information

Business Legal Name*DBA (Doing Business As)

Legal Entity*What industry are you in?*Federal Tax ID*Business Start Date*Business Phone Number*Website

Business Address*

Street AddressStreet Address Line 2

CityState / ProvincePostal / Zip Code

Owner Information

Owner Name*

First NameLast Name

Home Address*

Street AddressStreet Address Line 2

CityState / ProvincePostal / Zip Code

E-mail*Owner Mobile Number*Credit Score*Percent Ownership*Social Security Number*Date of birth*

Is there a second owner?

YesNo

Funding Details

Use of funds:*Total Monthly Sales:*Requested Funding Amount:*

Do you currently have funding from another lender*

NoYes

We fund Defaults! Please answer the below:*

I never defaultedI have defaulted in the past and have Zero Balance LettersI have defaulted and do not have Zero Balance Letters

Optionally - Is there anything else you would like to share with our underwriting team?Upload Last 3 months of bank statements & a month to date statement for the current month (Optionally: If you have zero balance letters upload them here)

Authorization

By signing, each of the above listed businesses and business owner/officer (individually and collectively, "you") authorize Paramount Capital LLC and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial business…

Signature*

Sign inside the box with your finger, mouse, or trackpad.