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Amount Requested*

Use of Funds

Business Legal Name*

Business DBA Name

Annual Business Revenue*

Entity Type*

Country*

State of Incorporation*

Fed Tax ID #*

Province of Incorporation*

BN Number*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Address*

Street Address Address Line 2 City Province Postal Code

Business Phone*

Mobile Phone*

Email*

Industry Type*

Business Start Date*

Owner's Information

Legal Name*

First Last

Ownership %*

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SSN*

Title*

SIN*

Title*

Date of Birth*

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Address*

Street Address Address Line 2 City Province Postal Code

Second Owner's Information

Legal Name

First Last

Ownership %

Please enter a number from 1 to 100.

Date of Birth

Mobile Number

SSN

Title

SIN

Title

Email

Home Address

Street Address Address Line 2 City State ZIP Code

Home Address

Street Address Address Line 2 City Province Postal Code

Disclosure*

By checking this box and clicking SUBMIT, I express my understanding and consent electronically via E-sign that I acknowledge, agree and consent to the Privacy Policy and Terms of Use which includes binding arbitration and I am providing express written consent for King Capital to contact me by calls and/or text at the phone number provided regarding scheduling and application status using any telephone dialing system, prerecorded/artificial voice messages and/or use of an automatic dialing device or system, as applicable sending text messages (Data & message rates may apply, messaging frequency varies: text HELP for help; text STOP to cancel) even if my telephone number is currently listed on any state or federal Do-Not-Call list. I may revoke this consent at any time and I am not required to opt in as a condition of these services. SMS consent will not be shared with third parties for their marketing purposes.

Authorizations: The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges, and agrees that (1) all information and documents provided to King Capital (“KC”) are true, accurate, and complete, (2) Applicant will immediately notify KC of any change in such financial condition, (3) KC and it’s affiliates are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that KC and it’s affiliates deem necessary, (4) Applicant waives and releases any claims against KC and any information-providers arising from any act or omission relating to the requesting, receiving, or release of information, and (5) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.

Message and data rates may apply if/when we text you with updates and follow up text messages regarding your funding offer. Message frequency varies. You can call our customer line at: 888-811-6101, to opt-out, or call for customer care information. If you are interesting in opting-out, text STOP to cancel. Click here to view Privacy Policy and Click here to Terms of Use.

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