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Application Form
Company Information
Business Name and DBA (if any)
Email
Address
Street Address
City
State
ZIP / Postal Code
Mobile Number
Fax Number
DOT or MC Authority #
State of Registration
Federal Tax ID
Date Established
Month
Day
Year
Business Type
C Corp
S Corp
LLC
Partnership
Sole Prop
State Organization ID
# Company Trucks
Other Information
Have your, this company, any of its officers or directors, or any affiliated companies ever:
Been convicted of a felony in the last 10 years?
Yes
No
Been past due or currently past due on taxes?
Yes
No
Filed Bankruptcy?
Yes
No
Company Owner(s)
Full Name
Title
Social Security Number
% of Ownership
Date of Birth
MM slash DD slash YYYY
Address
Street Address
City
State
ZIP / Postal Code
Drivers License #
State Issued
More Than One Owner/Officer?
Check to add another
Owner/Officer #2
Full Name
Title
Social Security Number
% of Ownership
Address
Street Address
City
State
ZIP / Postal Code
Drivers License #
State Issued
Salesperson You Are Working With:
How did you hear about iThrive:
Important Information
(Required)
By executing this application, the undersigned person(s) certifies to the following: That he/she is an authorized representative of the company and has authority to complete the application on behalf of the company; The information set forth in this application and in any documents, reports, statements, and/or other information provided to iThrive Funding, LLC (iThrive) are full, true, correct, and complete and accurately reflect such in formation on the date(s) thereof; that iThrive is authorized to request, receive, and verify credit reports and other financial information regarding applicant(s) and its business that iThrive deems necessary and appropriate; the iThrive is authorized to execute in the name of the undersigned person(s); and that iThrive is authorized to inquire of, investigate, confirm, and verify any information contained in this application, in any documents, reports, statements, and/or other information provided under or pursuant to this application, or learned by iThrive as part of its investigation and review of this application, applicant(s), or applicants' business. iThrive is authorized to file UCC Financing Statements concerning all accounts of applicant upon execution of this application. In the event funding does not occur, iThrive will terminate the filings.
I agree to these terms.
MUST BE SIGNED BY MAJORITY OWNER(S) OF THE COMPANY
Signed:
Date
Month
Day
Year
Signed:
Date
Month
Day
Year
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