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Funding Application

Business Information

Legal Company Name *

State of Incorporation *

Industry *

Amount Seeking *

Tax ID *

Business Inception Date *

Business Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Owner Information

Name *

First

Last

Email *

admin@fundgatellc.com

Phone

SSN/Social Security Number *

Date of Birth *

Home Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Ownership Percentage *

Please enter a number from 1 to 100.

Please upload the last 3 months of Business Bank Statements and a month to date statement.

Click or drag files to this area to upload. You can upload up to 5 files.

Accepted file types: pdf, Max. file size: 32 MB.

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