Funding Application — Selective Capital

📋 Business & Owner Details

Business Information

Legal Business Name *

EIN # *

Business Start Date *

Legal Entity Type *

Company Address *

Owner Information

Owner Full Name *

Ownership % *

SSN # *

Date of Birth *

Home Address *

Is there a second owner (20%-49%)?

No Yes

Second Owner Name

Second Owner SSN

Authorization

By submitting this application, you certify and confirm the following: (i) you are authorized to apply for funding on behalf of the Company, and (ii) all information provided herein, together with supporting documents, is true, accurate, and complete. You agree to immediately notify us of any changes to this information. You understand and agree that our agents and assignees are authorized to contact third parties to make inquiries in evaluating your application (including requesting Company and personal credit bureau reports from credit reporting agencies and other sources) or for any updates and renewals.

I agree to the above terms and authorize this application

Submitting...

✅

Application Submitted!

Thank you! Your funding application has been received. Our team will review your information and reach out within 24-48 hours with your approval details.

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