Business Information

Legal Company Name *State of Incorporation *CorporationLLCS CorporationSole ProprietorshipPartnershipTax ID *Business Inception Date *

Business Address

AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code

Owner Information

Name *FirstLastEmail *admin@fundgatellc.comPhoneSSN/Social Security Number *Date of Birth *

Home Address

AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness 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.

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Partner, Proprietor or Guarantor

Each of the signatories, whether serving as a Principal, Sole Proprietor, or Personal Guarantor for the aforementioned business, acknowledges that their personal credit history could play a role in the assessment of this business’s funding application. Each undersigned individual hereby grants “FUNDGATE” and its representatives, as well as affiliated partners of “FUNDGATE,” permission to access their credit reports (including any subsequent updates) in the context of “FUNDGATE” evaluation of this application and any affiliated partners’ subsequent account review for the aforementioned business. Each of the signatories hereby authorizes “FUNDGATE” to use their information, including but not limited to phone calls, emails, text messages, and direct mail, for marketing purposes by “FUNDGATE” and its affiliates.

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