Business Information Business Name* DBA (if applicable) Business Address* City* State* Zip Code* EIN / Federal Tax ID* Entity Type* LLCCorporationS-CorpSole ProprietorshipPartnershipOther State of Incorporation* Business Established Date* Owner Information Owner Full Name* Ownership %* Home Address* City* State* Zip Code* Phone Number* Email* SSN* Date of Birth* Funding Request Monthly Revenue* Under $30,000$30,000 - $50,000$50,000 - $100,000$100,000 - $250,000Over $250,000 Funding Amount Requested* $10,000 - $25,000$25,000 - $50,000$50,000 - $100,000$100,000 - $250,000$250,000 - $500,000$500,000+ Purpose of Funding* Working CapitalEquipment PurchaseInventoryBusiness ExpansionPayrollOther Current Business Advances or Loans* None123 or more Authorization & Signature By checking this box and typing my name below, I certify that I am an owner or authorized officer of the business named in this application and that all information and documents provided are true, correct and complete. I authorize Algo Advance LLC and its funding partners, agents and assigns to obtain business and personal credit reports, bank and processor statements, and any other information needed to verify this application, and to share this application and supporting documents with its funding partners. I agree that typing my name below is my electronic signature and has the same legal effect as a handwritten signature. Signature* (type your full legal name) Date & Time Signed
