APPLICATION - Harper Advance

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Business Contact Information
Legal Company Name*
Business Start Date*
MM slash DD slash YYYY
DBA*
Number of Owners
EIN | Tax ID*
Business Structure*
- Sole Proprietorship
- Corporation
- LLC
Registered Company Address*
Street Address Address Line 2 City 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 information will be used for site registration.
Password will be sent to the email you will use for the owner 1 information.
Business Owner Name*
First Last
Social Security Number*
Date Of Birth*
MM slash DD slash YYYY
Credit Score*
Home Address*
Street Address Address Line 2 City State ZIP Code
Email*
(Will be your username)
Enter Email Confirm Email
Ownership %*
Home Phone*
Mobile Phone*
Owner (2) Information
Business Owner Name*
First Last
Date Of Birth*
MM slash DD slash YYYY
Social Security Number*
Credit Score*
Email*
Home Address*
Street Address Address Line 2 City State ZIP Code
Ownership %*
Phone
Home Phone*
Mobile Phone*
Fax Number
Landlord Contact Information
Landlord Contact Name
First
Company Name
Phone
Do You...
- Rent
- Own
Rent / Mortgage Payment
Signatures
Owner (1) Name & Title*
Date
MM slash DD slash YYYY
Owner (2) Name & Title*
Date
MM slash DD slash YYYY
Upload Bank Statements
We need at least 3 months of bank and credit card processing statements.
Drop files here or

Max. file size: 128 MB.
By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Harper Advance and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial 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

Owner (2) Information

Landlord Contact Information

Signatures