Freedom Ventures Lending Application

First Name *

Last Name *

Phone *

Email *

Referral Contact *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication.

Address

City *

State *

Postal code *

FICO *

Are you a US Citizen *

Yes

No

Marital Status *

Dependents (if applicable)

Purpose of Funding *

Business Name *

Date Business Established *

Requested Funded Amount *

Monthly Revenue *

Industry Type *

Do you own any business real estate *

Yes

No

If yes, provide details (type, location, value)

Annual Revenue *

Do you own personal real estate? *

Yes

No

If yes, please provide details

Please provide estimated value

Do you own any other assets? *

Yes

No

If yes, please provide details and estimated value:

Do you have any outstanding liabilities or debts? *

Yes

No

If yes, please provide details and balances

We are looking for the following documents, if applicable:

□ Personal tax returns (most recent 2 years)

□ Business tax returns (most recent 2 years)

□ Debt schedule and P&L; summary if available

I have all the necessary documents accessible and ready. *

Yes

Please check if you need assistance with tax preparation or gathering documents

Yes, I would like assistance

By signing below, I confirm that the information provided is true, accurate, and complete.

I understand that Freedom Ventures Group (FVG) and its referral partners assume no liability for decisions made based on this application.

Signature *

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