← OCTIS FINANCE
Business Funding Application
Complete the application below — everything is on one page.
Application Details
Date
*
Email
*
Intended Use of Funds
*
Funding Program
Octis Finance Funding Solutions
Select the program that best matches your business funding needs.
Merchant Cash Advance
SBA Loan
Term Loan
Financing Amount Requested
*
Business Information
Legal Company Name
*
DBA / Other Legal Entity
Business Inception Date
*
State of Incorporation
Federal Tax ID / EIN
Company Phone
*
Physical Business Address
*
City
*
State
*
ZIP Code
*
Business Type / Industry
*
Legal Entity
Corporation
LLC
General Partnership
LLP
Other
Premises
Rent
Own
Landlord Name
Landlord Phone
Business & Financial Information
Separate business bank account?
*
Yes
No
Accepted credit cards for at least 3 months?
*
Yes
No
Annual Business Revenue
*
Average Bank Balance
Monthly Credit Card Volume
Outstanding MCA?
Yes
No
Outstanding MCA Amount
Owner / Signature 1 — Primary Owner
Complete all Owner 1 information. SSN is required.
First Name
*
Middle Name
Last Name
*
Email
*
Home Phone
Cell Phone
*
SSN
*
Date of Birth
*
Ownership %
*
Annual Income
*
Credit Score
Home Address (No PO Boxes)
*
City
*
State
*
ZIP Code
*
Owner / Signature 2
(Optional)
If there is no secondary owner, leave this section blank.
First Name
Middle Name
Last Name
Email
Home Phone
Cell Phone
SSN
Date of Birth
Ownership %
Annual Income
Credit Score
Home Address
City
State
ZIP Code
Business Questions
Is the business seasonal?
Yes
No
Any open bankruptcies?
Yes
No
Any judgments or liens?
Yes
No
Additional Notes
Bank Statements
(Optional)
You may upload up to
4 PDF bank statements
for the most recent four months.
This section is optional.
You can submit the application without uploading any bank statements.
Bank Statement — Month 1
(Optional)
Bank Statement — Month 2
(Optional)
Bank Statement — Month 3
(Optional)
Bank Statement — Month 4
(Optional)
Authorization & Signature
By submitting this application, I/We certify that the information provided is complete, true and accurate and authorize Octis Finance and its authorized funding partners to review information reasonably necessary to evaluate this business funding request and to contact me regarding the application.
I/We have read and accept the authorization above.
*
Owner 1 Signature
*
Owner 2 Signature
Signature Date
*
Submit Application