APPLICATION - Harper Advance

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Business Contact Information
Legal Company Name*
Business Start Date*
DBA*
Number of Owners
12
EIN | Tax ID*
Business Structure*
- Sole Proprietorship
- Corporation
- LLC
Registered Company Address*

Street Address

Address Line 2

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
State

ZIP Code
Phone*
Fax
Annual Business Revenue*
Description Of Business*
Existing MCA
- Yes
- No
With Which Company
Desired Amount
Purpose Of Funding
Owner (1) Information

Owner 1 Details will be used for site registration.
Password will be send the email you will used for the owner 1 information.
Business Owner Name*

First

Last
Social Security Number*
Date Of Birth*
Credit Score*
Home Address*

Street Address

Address Line 2

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
State

ZIP Code
Email*
(Will be your username)

Enter Email

Confirm Email
Ownership %*
Home Phone*
Mobile Phone*
Fax Number
Landlord Contact Information
Business Owner Name*

First

Last
Date Of Birth*
Social Security Number*
Credit Score*
Email*
Home Address*

Street Address

Address Line 2

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
State

ZIP Code
Do You…
- Rent
- Own
Ownership %*
Phone
Home Phone*
Mobile Phone*
Rent / Mortgage Payment
Fax Number
Signatures
Owner (1) Name & Title*
Date
Upload Bank Statements
We need at least 3 months of bank and credit card processing statements.
Drop files here or
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize [Gold Bear Capital] (“GBC”) 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 therefore (collectively, “Transactions”) to obtain consumer 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.

Business Contact Information

Owner (1) Information

Landlord Contact Information

Signatures