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Legal Business Name *
DBA/Trade Name *
Federal Tax ID EIN *
Hawaii GET (General Excise Tax) ID *
Business License #
Professional License #
Business Start Date *
Years in Business *
Years at Current Location *
Business Location
Business Street Address *
Suite/Unit
City *
State *
Zip *
Owner Contact
Phone Number *
Website *
Email *
Business Description
Legal Entity Type *
State of Incorporation *
Business Classification
Primary Industry *
NAICS Code
Briefly describe your business *
(150 words max)
Social (optional)
Facebook
Instagram
TikTok
Other
Page 2
Owner Information
First Name *
Last Name *
Date of Birth *
SSN *
Drivers License # *
Driver License State *
Home Address *
Location Type *
Estimated Square ft.
Rent or Own? *
Monthly Lease ($) *
Years at Current Business Address *
Business Owner
Percent of
Ownership *
If not 100% owner, please complete the following
Additional Owner Full Name
Email
Phone Number
Page 3
Business Financials
Avg Monthly Revenue (in dollars $) *
Avg Monthly Credit Card Sales (in dollars $) *
Number of
Deposits/Month *
Avg Deposit Amount (in dollars $) *
Credit Card Processing
Name of
Processor *
Years with Processor *
#Transactions per Month *
Banking
Primary Bank *
Years with Primary Bank *
Avg Daily Balance (in dollars $) *
Page 4
Funding Request
Use of Funds Description (Max 150) *
Funds
Urgency Level *
Preferred Advance Amount $ *
Preferred Funding
Date *
Other Loans
or Advances? *
If you have other loans or Advances, please list lender/provider, amount, start date, balance remaining
Employees and Payroll
Total Employees (including self) *
Full-Time
Employees
Part-Time
Seasonal
Monthly Payroll ( in dollars $ ) *
Number
of Locations *
Licenses and Compliance
Hawaii Business License Active?
Workers Comp Insurance Active?
Professional License Active?
General Liability Insurance?
Any Tax
Liens? *
Page 5
Business Reference
Reference Full Name *
Relationship Type *
Years of Relationship *
I agree with the Terms & Conditions
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Page 1 / 1
Federal Tax ID/EIN *
Federal Tax ID
EIN *
Suite
/Unit
Location
Type *
Estimated Square footage (feet)
Rent or
Own? *
Monthly Lease or Mortgage (in dollars $) *
# Transactions/Month *
Urgency
Level *
Total Employees (including yourself) *
