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Limited time opportunity
Save 20% on your remaining balance when you renew by October 31, 2023.
Full Funding Application 20% Off Promo
First Name
(Required)
Last Name
(Required)
Email Address
(Required)
Business Phone Number
(Required)
Business Legal Name
(Required)
Business DBA Name
(Required)
Business Start Date
(Required)
MM slash DD slash YYYY
Federal Tax ID #
(Required)
Legal Entity Proprietor
(Required)
Corporation
LLC
Sole Proprietor
Partnership
Business Address
(Required)
Business City
(Required)
Business State
(Required)
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
Business Zip Code
(Required)
Mobile Number
(Required)
Business Website
Type of Business
(Required)
Agriculture
Construction
Finance, Insurance, Real Estate
Manufacturing
Mining
Public Administration
Services
Transportation & Public Utilities
Wholesale
Retail
eCommerce
Intermediaries
Other
Owner Name
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Ownership %
(Required)
Multiple Owners
(Required)
Yes
No
Second Owner Name
Social Security Number
(Required)
Home Address
(Required)
Home City
(Required)
Home State
(Required)
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
Home Zip Code
(Required)
Do you own multiple businesses?
(Required)
Yes
No
Are you working with a Reliant Rep?
(Required)
Yes
No
If yes, who is your rep?
Agreement
(Required)
I agree to the below
The Merchant and Owner(s)/Officer(s) identified above (individually, and "Applicant") each represents, acknowledges and agrees that (1) all the information and documents provided to The LCF Group ("Representative") including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain including credit reports to the other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables, including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "Transactions"), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, "Recipients") are authorized to request and receive and investigative reports, credit reports, statements from creditors or financial institutions, verification information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases and claims against Recipients and any other information-providers arising from any act or omission relating to the requesting, receiving, or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant. A copy of this authorization may be accepted as an original.
Consent
(Required)
I agree to the
privacy policy
Consent
(Required)
I swear or affirm that I am the party described above and that all statments in this application, including those pertaining to my identity are true.
Signature
(Required)
Sign Date
(Required)
MM slash DD slash YYYY