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APPLICATION
Your Business Loan Partner
FlatRock Capital Partners | Apply Now
Step
1
of
3
- Business Information
0%
Legal Business Name
(Required)
DBA (Doing Business As)
Business Description
(Required)
Tax ID #
(Required)
Business Start Date
(Required)
MM slash DD slash YYYY
Business Address
(Required)
Street Address
City
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
Business Phone Number
(Required)
Entity Type
(Required)
Corporation
LLC
LLP
Ltd. Partnership
Partnership
Sole Proprietor
Name
(Required)
First
Last
Email
(Required)
Phone number
(Required)
Ownership Percentage
(Required)
Please enter a number from
1
to
100
.
Owner's Home Address
(Required)
Street Address
City
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
Owner's Home Address
SSN
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Does your business have a second owner with 50% or more ownership?*
(Required)
Yes
No
Are they able to fill out their information now or at a later date?*
(Required)
Yes
No
Secondary Owner's Information
Second Owner's Name
(Required)
First
Last
Second Business Owner Name
Second Owner's Email
(Required)
Second Owner's Phone number
(Required)
Second Owners Phone number
Second Owner's Ownership Percentage
(Required)
Please enter a number from
1
to
100
.
Second Owners Home Address
(Required)
Street Address
City
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
Second Owner's SSN
(Required)
Second Owner's Date of Birth
(Required)
MM slash DD slash YYYY
How would you like to send the shorter application version link to the other owner?
(Required)
Email
It will be completed at a later date
Email to Send Application to Second Owner
(Required)
Requested Amount
(Required)
Estimated Gross Annual Revenue
(Required)
This field is hidden when viewing the form
Will you be submitting your bank statements via this online form?
No
Yes
Bank Statement 1
Max. file size: 50 MB.
Bank Statement 2
Max. file size: 50 MB.
Bank Statement 3
Max. file size: 50 MB.
Month-to-date Upload
Max. file size: 50 MB.
Additional Files
Drop files here or
Select files
Max. file size: 50 MB.
Add any additional supporting documents here.
Industry
(Required)
Agriculture and Landscaping
Apparel and Accessories
Automotive/Bicycle
Auto Sales
Beauty Salon / Spa
Building Materials
Business Services
Construction
Electronics
Garden Store
General Merchandise
Grocery and Baked Goods
Health Services
Home Furnishing
Hotel, Motel, and Lodging
Laundry and Garment Services
Manufacturing
Recreation
Restaurant/Bar
Retail Store
Travel and Transportation
Trucking
Veterinary Clinic
Wholesale
Other
Industry if Other
Date (Owner 1)
(Required)
MM slash DD slash YYYY
Signature
(Required)
Signature Authorization
(Required)
I Understand
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize FlatRock Capital Partners. 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 and/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 FlatRock Capital Partners to transmit this application form, 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 FlatRock Capital Partners and to each of the Recipients, on its own behalf. I am providing my business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions withFlatRock Capital Partners and/or its affiliates on either medium. I also hereby consent to the receipt of text messages knowing that msg. and data rates may apply. I understand that consent to receive texts is not a condition of approval. I can expect approx. 10 msgs./month. I/we certify that all the information contained herein is complete, true and accurate. Any lender receiving the application is authorized to contact the applicant via telephone or text message for marketing purposes, even if the provided phone numbers are on any state, federal, or corporate do-not-call registry.