Working Capital Application - with Geneva Capital, LLC.

Primary business contact first name *

Primary business contact last name *

Primary business contact email *

Primary business contact cell # *

Dollar amount requested *

* indicates a required field

Business Information

Check if business is not yet formed

Business name *

DBA

Legal structure

Federal tax ID

Date established month *

Date established year *

Phone # *

Address line 1 *

Address line 2

City *

State *

ZIP Code *

Continue

Add Guarantor/Owner

Guarantor(s)/Owner(s)

Guarantor/Owner #1

Same as primary contact?

First name *

Middle name

Last name *

Suffix

Email *

Phone # *

Cell # *

Home Address (with apt if applicable) *

City *

State *

ZIP Code *

Citizenship status *

Marital status *

Date of birth (MM/DD/YYYY) *

Month (MM)

Day (DD)

Year (YYYY)

Social security number *

Percent of ownership *

Please represent 100% ownership on this application. If business is solely owned, spousal information is required on this application.

Remove Guarantor/Owner #1

Questions

Andy Erickson, Geneva Capital LLC
1311 Broadway Street
Alexandria, MN 56308

andye@gogc.com or 3207593523

By checking this box, the applicant(s) certifies that all information contained in this application, and all attachments hereto, are true and accurate to the best of the applicant(s) knowledge and are made for the purpose of obtaining credit for business purposes, and not for personal or family use. The applicant(s) hereby authorize Geneva Capital, LLC. and its assigns to obtain and use consumer credit reports on the undersigned, now and from time to time, as may be needed in the credit evaluation and review process if credit is extended and waives any right or claim the applicant(s) would otherwise have under the Fair Credit Reporting Act in absence of this continuing consent. The applicant(s) further authorize any government agency, bank or financial institution to release credit information on the applicant(s) accounts to Geneva Capital, LLC. and its assigns. If credit is extended, Applicant agrees that by selecting the “Submit Application Securely” button this electronically transmitted application shall be deemed to be binding, valid, genuine and authentic as an original-signature document for all purposes. The applicant(s) further authorize Geneva Capital, LLC. to mail, text, fax or e-mail solicitations of future lease financing services to applicant and or collections of payment.

I have read and agreed to the above terms and conditions *