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1
Owner Information
2
Business Information
3
Documents & Signature
First Name
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Last Name
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Social Security Number
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Date of Birth
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MM slash DD slash YYYY
Personal Credit Score
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Home Address
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Business Ownership %
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Would you like to add an additional owner?
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Additional Owner Information
First Name
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Last Name
*
Email Address
*
Mobile Phone
*
Social Security Number
*
Date of Birth
*
MM slash DD slash YYYY
Personal Credit Score
*
Please enter a number from
0
to
850
.
Home Address
*
Street Address
Address Line 2
City
State
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Alaska
American Samoa
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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Oregon
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Ownership %
*
Please enter a number from
1
to
100
.
Business Legal Name
*
Business DBA
Business Phone
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Industry
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Accounting/Finance
Advertising/Public Relations
Aerospace/Aviation
Arts/Entertainment/Publishing
Automotive
Banking/Mortgage
Business Development
Business Opportunity
Clerical/Administrative
Construction/Facilities
Consumer Goods
Customer Service
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Insurance
Internet
Job Search Aids
Law Enforcement/Security
Legal
Management/Executive
Manufacturing/Operations
Marketing
Non-Profit/Volunteer
Pharmaceutical/Biotech
Professional Services
QA/Quality Control
Real Estate
Restaurant/Food Service
Retail
Sales
Science/Research
Skilled Labor
Technology
Telecommunications
Transportation/Logistics
Other
Business Website
Number of Employees
*
Entity
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Corporation
LLC
Sole Proprietorship
LLP
Ltd. Partnership
Partnership
EIN / Tax ID
*
State of Incorporation
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Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Business Start Date
*
MM slash DD slash YYYY
How Long Has The Business Been Operating?
*
Please Select One
Pre-Revenue Or Early Stage
1 – 2 Years
2 – 4 Years
4+ Years
Annual Revenue
*
Average Monthly Sales (Prior 3-months)
*
What's Your Business Credit Profile?
*
Please Select One
Strong / Institutional Quality (720+)
Good, With Some Complexity (680–719)
Transitional Or Situational (600–679)
Prefer To Discuss
Business Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Type of Financing Requested
*
Please Select One
Asset-Based Lending
Working Capital Solutions
Equipment & Asset Financing
Bridge & Short-Term Financing
Acquisition & Growth Financing
Commercial Real Estate Financing
SBA & Government-Backed Loans
Bespoke & Structured Credit
Requested Financing Amount
*
Desired Funding Timeline
*
Please Select One
Immediate (0–30 days)
30–60 days
60–90 days
Flexible / Opportunistic
What will the proceeds be used for?
*
Documentation for Asset-Based Lending (ABL)
Business tax returns (Prior 2-years)
Business financial statements (Balance Sheet & P&L - Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Current accounts receivable and accounts payable aging report
Additional Documentation
Inventory reports (By category, if applicable)
Equipment schedule (If equipment included as collateral)
Collateral appraisals (Inventory, equipment, receivables, if available)
Existing UCC filings and lien information
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Working Capital Solutions
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Current accounts receivable and accounts payable aging report
Personal financial statement (For guarantors)
Personal tax returns (Prior 3 years, owners >20%)
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Equipment & Asset Financing
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Equipment invoice, quote, or purchase agreement
Equipment details (Make, model, year, serial numbers)
Equipment appraisal or valuation (If used equipment or refinance)
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Bridge & Short-Term Financing
Business tax returns (Prior 2-years, if available)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Purchase agreement or existing loan payoff statement
Property or collateral details (Address and description)
Appraisal or broker opinion of value (If available)
Basic rent roll or income summary (If applicable)
Personal financial statement (For guarantors)
Exit strategy summary
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Acquisition & Growth Financing
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Purchase agreement or LOI
Seller financial statements (Prior 2-years and YTD)
Sources and uses of funds
Equity injection amount and source
Buyer background (Resume or experience summary)
Personal financial statement (For guarantors)
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Commercial Real Estate Financing
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Appraisal or broker opinion of value
Purchase agreement or refinance details
Rent roll and leases (If investment property)
Trailing 12-month operating statement (T-12)
Schedule of real estate owned
Personal financial statement (For guarantors)
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for SBA & Government-Backed Loans
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Owner and management resumes
Lease or purchase agreements
Business plan with financial projections
Personal tax returns (Prior 3 years, owners >20%)
Personal financial statement
Current accounts receivable and accounts payable aging report (If applicable)
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
Documentation for Bespoke & Structured Credit
Business tax returns (Prior 2-years)
Business financial statements (Prior 2-years and YTD)
Current business debt schedule (All loans, advances, and obligations)
Bank statements (Last 6 months)
Capital structure summary
Asset schedules (If applicable)
Transaction overview or use-of-funds summary
Exit or capital event timeline
Note: Start with the documents you have on hand. Any remaining materials can be submitted at your convenience.
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Legal Agreement
*
By checking this checkbox I agree to the terms and conditions outlined below.
The Business and the Business Owner(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Bizi Connect LLC (“Bizi Connect”) are true, accurate and complete, (2) Applicant will immediately notify Bizi Connect LLC of any change in such information or financial condition, (3) Applicant authorizes Bizi Connect LLC to disclose all personal and/or business information and documents that Bizi Connect LLC may obtain, including credit reports and personal information and any information that Applicant may provide to Bizi Connect LLC in Applicant’s application(s) for any product, service or program through Bizi Connect LLC, to other persons, entities or third-parties that facilitate financing (collectively, “Assignees and Third-Parties”), as follows: (a) to Assignees and Third-Parties that may make, be involved with, or acquire commercial financing programs having daily, weekly, bi-weekly or monthly repayment features, (b) to Assignees and Third-Parties that may be involved with purchases of future receivables including Merchant Cash Advance transactions, and (c) to Assignees and Third-Parties for the purpose of offering Applicant our products, services or programs or those of third parties that Bizi Connect LLC believes Applicant may find of interest, including, without limitation, equipment finance and/or equipment leasing programs and services (collectively, “Transaction”) and each Assignee and Third-Party is authorized to use such information and documents, and share such information and documents with other Assignees and Third-Parties, in connection with potential Transactions, (4) each Assignee and Third-Party will rely upon the accuracy and completeness of such information and documents, (5) Bizi Connect LLC, Assignees, Third-Parties, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of information, (7) without a requirement of purchase Applicant authorizes Bizi Connect LLC to disclose all information and documents that Bizi Connect LLC may obtain including credit reports to other persons or entities (collectively “Credit Service Organizations”) that may be able to assist the Applicant in removing or correcting any inaccurate items appearing on the Applicant’s credit report(s), and Applicant further authorizes any Assignees, Third-Parties, Credit Service Organizations, or agents or representatives of Bizi Connect LLC to contact Applicant on any telephone number provided by Applicant irrespective of whether such telephone number(s) appear(s) on any “Do Not Call” lists and through the use of SMS text or an autodialed telephone call that may include a pre-recorded message, (8) to the extent allowable by law Applicant may opt out of any of the above stated authorizations by contacting (833) 740-2494 with the understanding that such an opt-out may limit the services Bizi Connect LLC may provide Applicant and with the further understanding that such an opt-out will have no effect whatsoever on any funds owed by the Applicant, (9) each Signatory represents that he or she is authorized to sign this form on behalf of the Applicant and Business Owner(s), (10) Applicant hereby consents and agrees, on behalf of itself, as well as Business Owner(s), that Bizi Connect LLC, Assignees, and Third-Parties, including their agents or representatives may contact Applicant and/or Business Owner(s), by email (including, without limitation, adding Applicant and/or Business Owner(s) to our newsletter mailing list), using information which Applicant and/or Business Owner(s) or their agents, employees or representatives have provided to Bizi Connect LLC, or any other information which is publicly available, (11) Applicant hereby consents and agrees to the collection and disclosure of its business and/or personal information, both online and offline, to be disclosed to (i) Bizi Connect LLC’s subsidiaries and affiliates; (ii) to contractors, service providers, vendors, and other third parties Bizi Connect LLC uses to support its business; (iii) Assignees and Third Parties; (iv) to respond to subpoenas, court orders, legal process, or to establish or exercise Bizi Connect LLC’s legal rights or defend against legal claims; (v) to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations involving potential threats to physical safety of any person, violation of Bizi Connect LLC’s terms or agreements, or as otherwise required by law; (vi) to a buyer or other successor in the event of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of Bizi Connect LLC’s assets, whether as a going concern or as part of bankruptcy, liquidation, or similar proceeding, in which Applicant’s personal information is among the assets transferred; and/or (vii) for the purposes stated in Bizi Connect LLC’s Privacy Policy, and Applicant agrees that any additional use of its information not outlined above or in the Privacy Policy may be disclosed and consented to orally, which oral consent will be treated as if in writing. I understand that this consent is not a condition of purchase.
Owner Signature
*
Co-Owner Signature
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Date
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Business Financing
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Equipment & Asset Financing
Bridge & Short-Term Financing
Acquisition & Growth Financing
Commercial Real Estate Financing
SBA & Government-Backed Loans
Bespoke & Structured Credit
About Us
Careers
Become a Partner
Contact Us
Apply Now