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First name:
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Last name:
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Phone number:
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Amount Requested:
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Use of Funds:
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Company Name:
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DBA:
Physical Address:
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City:
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State:
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Is mailing address same as physical address?
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Mailing Address:
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City:
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State:
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Washington
Washington, D.C.
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ZIP:
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When was the business founded?
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Length of Ownership?
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State of Incorporation?
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
FEIN / Tax ID:
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Entity Type:
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Sole Proprietorship
Limited Partnership (LP)
Limited Liability Partnership (LLP)
Limited Liability Company (LLC)
Corporation (C-Corp)
S Corporation (S-Corp)
Nonprofit Organization
Franchise
Holding Company
Industry/Service Provided:
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Annual Revenue:
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Do you currently have any financing/loans?
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No
Yes
What is your outstanding balance?
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Are you the sole owner?
Yes
No
Owner's First Name
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Owner's Last Name
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Home Address:
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City:
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State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
ZIP code:
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Cell phone number:
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Email:
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Date of Birth:
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SSN:
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Ownership %?
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FICO Score:
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2nd Owner's First Name
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2nd Owner's Last Name
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2nd Owner's Home Address:
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2nd Owner's City:
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2nd Owner's State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
2nd Owner's ZIP code:
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2nd Owner's Cell phone number:
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2nd Owner's Date of Birth:
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2nd Owner's SSN:
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2nd Owner's Ownership %?
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2nd Owner's FICO Score:
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Consent and Authorization:
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I authorize Poseidon Financial Network to work on my behalf.
By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Poseidon Financial Network LLC ("PFN") and each of its representatives, successors, assignees and designees ("Recipients") that may be involved with or acquire commercial loans having daily repayment feature for purchases of future receivables including merchant cash advance transactions including without limitation the application therefor (collectively, "Transactions") to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks creditors and other third parties.You further you agree to receive phone calls and SMS messages from PFN regarding our products and services at the phone number provided. Your contact information will not be shared with third parties or affiliates for marketing or promotional purposes. You also authorize PFN to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to PFN and to each of the Recipients, on its own behalf.
Signature
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Date
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2nd Owner's Signature
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Date
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MM slash DD slash YYYY
Application