Form

Basic Information

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Legal Business Name*

DBA Name (optional)

First Name*

Last Name*

Email*

Enter personal information

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Home Address*

City*

State/Region*

Zip Code*

Enter business information

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Business Address*

City*

State/Region*

Zip Code*

Business phone Number*

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Tell us more about your business

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Business Type*

Business Start Date*

Product/service sold*

Monthly revenue*

Requested Funding Amount*

Verify identity and ownership

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Birth Date

Socail Security Number

EIN

Ownership%

NO EIN

Upload Your Last 4 Months of Business Bank Statements

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Bank statements

We must receive your business bank statements in order to process your application and generate offer(s). Upload them now or email us at Caleb@stillwellfunding.com with your statements later.

Sign and certify

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By signing below each of the above listed business and business owner/officer individually and collectively, "you" authorize "STILLWELL FUNDING" and each of its representatives, successors, assigns and designees “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, “Transactions” 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, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize STILLWELL FUNDING to transmit this application form, along with any of the foregoing information obtained in connection with this application, 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 STILLWELL FUNDING and each of the Recipients, on its own behalf.

By clicking the submit button, I agree to terms & conditions. *