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Business Information

Please provide your business details

Legal Business Name *

State of Incorporation *

Business DBA Name *

Tax ID # *

Entity Structure *

Select

LLC

Corporation

Sole Proprietorship

Partnership

Other

Business Start Date *

Industry *

Business Phone # *

Business Address *

City *

State *

Zip Code *

Amount Requested *

Use of Proceeds *

Average Daily Balance *

Website *

Seasonal Business *

YESNO

Peak Sales Months *

Select months

January February March April May June July August September October November December

Monthly Gross Revenue *

Annual Gross Revenue *