Immediate Application Process Step 1 of 2 50% Today's Date(Required) MM slash DD slash YYYY Loan Amount Requested?(Required)$50,000-$100,000$100,000-$250,000$250,000-$500,000$500,000-$1,000,000$1,000,000-$2,500,000$2,500,000-$5,000,000$5,000,000-$15,000,000Average Monthly Business Revenue(Required)$30,000-$50,000$50,000-$100,000$100,000-$250,000$500,000-$1,000,000$1,000,000-$2,500,000$2,500,000-$5,000,000$5,000,000-$15,000,000+Intended use of funds(Required)Working Capital / Cash Flow ImprovementMarketing / AdvertisingExpansionEquipment PurchaseRenovationsProjectsSupplies / Material / InventoryCOMPANY INFORMATIONLegal Company Name(Required) Doing Business As (DBA) Tax ID(Required) Physical Address (No P.O. Box):(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company Phone(Required)Business Inception Date:(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you have a business checking account?(Required) Yes No Legal Entity(Required) Corporation General Partnership Sole Proprietorship LLC LLP HiddenDo you have an outstanding merchant cash advance? Yes No Hiddenit is $(Required) Company Type/ Industry(Required) State of Incorporation(Required) HiddenAny Open Judgements? Yes No HiddenAny Bankruptcy? Yes No HiddenAny Tax Liens? Yes No HiddenIs Business Seasonal? Yes No REQUIRED FOR RECOMMENDED LOAN AMOUNT OWNER INFORMATIONFirst Name(Required) MI Last Name(Required) Email(Required) Cell Phone(Required)Social Security Number(Required) Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Address (No P.O. Box)(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code % Ownership(Required) First Name(Required) MI Last Name(Required) Email(Required) Cell Phone(Required)Social Security Number(Required) Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Address (No P.O. Box)(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code % Ownership(Required) By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize VIP Capital Funding LLC, and each of its representatives, successors, assigns and designnees representatives, ("Recipients") 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, "Transac- tions") 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, Expe- rian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize VIP Capital Fund- ing to transmit this application form, along with any of the foregoing information obtained in connection with this applica- tion, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to VIP Capital Funding and to each of the Recipients, on its own behalf.Signature (1)(Required)Signature (2)(Required)Please upload your last 3 or 4 months business bank statements for immediate processing. Drop files here or Select files Max. file size: 100 MB. PhoneThis field is for validation purposes and should be left unchanged.
