Internal Processor Form — FundRight Capital

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Business Information

Legal Entity Name *

Date Business Started *

DBA

Business Phone *

Street Address *

Federal Tax ID *

City *

State *

Zip *

Type of Entity *

Sole Proprietorship Partnership Corporation LLC Other

Annual Revenue *

Requested Funding Amount *

Industry *

Website

Use of Funds *

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Owner Information

Owner Name *

Date of Birth *

Ownership % *

Credit Score *

Social Security # *

Home Address *

City *

State *

Zip *

Cell Phone *

Email *

Do you own real estate?

Yes No

Does business accept credit cards?

Yes No

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Partner Information (if applicable)

Partner Name

Date of Birth

Ownership %

Credit Score

Social Security #

Home Address

City

State

Zip

Cell Phone

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Bank Statements

Upload up to 4 months of business bank statements plus month-to-date activity.

Month to Date Activity

Month 1

Month 2

Month 3

Month 4

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Processor Notes

Internal Notes

Processor Name *

Date Submitted *

Internal use only — do not share this URL with customers

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Application Submitted!

The application has been logged and sent to Gemini Business Funding.