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Business Information
Owner Details
Capital Information
Step
1
of
14
- Business Information
7%
Legal Business Name
(Required)
DBA Name
Federal Tax ID
Industry
Time in Business
(Required)
Please Select One
Less than 1 Year
1 - 2 Years
2 years or more
Business Start Date
MM slash DD slash YYYY
Website (Old Field)
Business Phone
Website
Business Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
State of Incorporation
(Required)
Please Select One
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Structure
(Required)
Corporation
LLC
LLP
Partnership
Sole Proprietor
Seasonal Business
Yes
No
Property Information
Mortgage
Own
Rent
Monthly Property Payment
Average Gross Annual Revenue
(Required)
Please Select One
Less than $100k
$100k - $299k
$300k - $399k
$400k - $499k
$500k+
Gross Annual Sales
Is Credit Card Sales Part of Income?
Yes
No
Avg Monthly Credit Card Sales
Owner Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
SSN
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Email
(Required)
Phone
(Required)
Open Bankruptcies
Yes
No
Open Judgements/Liens
Yes
No
Bankruptcy Type
Ownership %
(Required)
Please enter a number from
1
to
100
.
Are there other owners?
Yes
No
Copy of Drivers License/State ID
Drop files here or
Select files
Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.
Last 3 months Bank Statements
Drop files here or
Select files
Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.
Amount Requested
(Required)
Use of Funds
(Required)
Do you currently have any working capital loans?
(Required)
Yes
No
Balance
Authorization Agreement
(Required)
I agree to the following authorization statement.
By signing below, the Business and Owner(s) identified above (individually, an “Applicant”) each represents, acknowledges, and agrees that (1) all information and documents provided in connection with this application are true, accurate, and complete; (2) Applicant will immediately notify Eliot Ventures LLC (“Denali Advance”) of any change in the Business’ financial condition; (3) Applicant understands that Denali Advance may share this information with its representatives, successors, assignees, affiliates and partners as well as third-party lenders/funders and their servicers and financial institutions (“Recipients’); (4) Applicant authorizes Denali Advance and Recipients to request and receive any investigative reports, consumer credit reports, trade references, statements from creditors or financial institutions, verifications of information, or any other information that Denali Advance and/or Recipients deem necessary, (5) Applicant waives and releases any claims against Denali Advance, Recipients and any information-providers arising from any act or omission relating to the requesting, receiving, or release of information, (6) each Owner of the Business represents that he or she is authorized to sign and submit this application on behalf of Business. Additionally, Applicant consents to communications with respect to funding matters from Denali Advance and Recipients by any medium not prohibited by law, including but not limited to mail, e-mail, cellular phone, text message, facsimile, and other forms of electronic communications.
Signature
(Required)
Printed Name
(Required)
Date
(Required)
MM slash DD slash YYYY
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