Contact & Basic Business Info BUSINESS NAME * DBA Doing Business As State of Incorporation * Industry Business Start Date * MM DD YYYY Federal Tax ID * Enter your 9-digit EIN number (no dashes) Business Email * Website http:// Business Phone * (###) ### #### Ownership % * Business Address Address 1 Address 2 City State/Province Zip/Postal Code Country Number of Employees Do you process credit cards? CURRENT CREDIT SCORE * Monthly Revenue * Estimate average gross revenue from the past 3 months $ GROSS ANNUAL SALES * $ Current Business Debt $ Bank Name For Current Business Debt REQUESTED AMOUNT * $ Brief description of usage of funds. * Contact Information information about the business owner or majority partner Name * First Name Last Name Date of Birth * MM DD YYYY TITLE * SSN * Enter your 9-digit number (no dashes) Email * Mobile Phone * (###) ### #### Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country PARTNER INFORMATION Partner Name First Name Last Name Partner Date of Birth MM DD YYYY PARTNER TITLE Partner SSN Partner Business Email Partner Mobile Phone (###) ### #### Partner Street Address City ZIP / Postal Code Partner Ownership % Partner FICO Score Rep Name * -- Please Select a Rep -- Brenda Daniel Danielle Edward Jonathan Karina Kevin Michael Paul Simon Zack Applicant Signature * Typing your name acts as a legally binding digital signature. Partner Signature * Typing your name acts as a legally binding digital signature. Text I authorize Wellspring Capital to obtain my credit and background information, including business and personal credit reports, for the purpose of evaluating my application. I affirm that the information provided is accurate and complete. I consent to be contacted via phone, email, or text. ✅ Application Received!Thank you for submitting your application to Wellspring Capital. Our team has received your information and is reviewing it now.A loan specialist will contact you shortly to discuss the next steps.If you have any questions in the meantime, feel free to contact us:📞 516-590-6070 📧 underwriting@wsc.finance
