Funding Application

Please complete this application and upload your 4 months of bank statements below to receive a secure approvals and funding options. PHONE: (888) 533-0162 Email: admin@greatenergycapital.com

A. BUSINESS INFORMATION

Business Legal Name:

Business DBA Name:

Street Address

City:

State

Zip:

Phone

Product / Service Sold

Mobile

Legal Entity

Fax:

Business Location

Date Business Started:

Federal State Tax #

B. OWNER/PRINCIPLE INFORMATION

Name:

Address:

City, State Zip:

Phone::

Email:

% of Ownership:

Date of Birth:

SSN#:

Credit Score:

OWNER #2 (IF APPLICABLE)

Name:

Address:

City, State Zip:

Phone:

Email:

% of Ownership:

Date of Birth:

SSN#:

Credit Score:

C. FINANCIAL INFORMATION

Amount of Funding Requesting:

Purpose of Funds:

Existing Advances:

Yes No

Outstanding Balances:

Current Advances with:

Payment:

D. LANDLORD OR MORTGAGE INFORMATION

Rent / Mortgage Monthly Amount:

Landlord / Mortgage Contact:

Landlord / Mortgage Number:

By signing below, the Merchant and it's owners / principals: (1) certify that all information and documents submitted in connection with this Application is true, correct and complete; and (2) authorize Great Energy Capital LLC and it's assignees to obtain credit reports and any other information regarding the Merchant and its owners and principals, to verify any information provided on the Application.

Owner/Principle Signature:

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Funding Application