Partner With Us Application This application will gather information about you and your business. It generally takes 5 minutes to complete. There are no fees and no obligations to apply. Of course, any questions, at any time, simply contact us. * All fields are required Unique IDPersonal InformationName* First Last Email* Phone*Home Address*Home City*Home State*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanHome Zip*Business Reference #1 - Name / Email / Tel #*Business Reference #2 - Name / Email / Tel #*Business InformationLegal Business Name*DBA (if different)Business Phone*Business Address*Business City*Business State*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioQuebecPrince Edward IslandSaskatchewanBusiness Zip Code*WebsiteLegal Entity Type*-- Select --CorporationGeneral PartnershipLimited Liability CorporationLimited Liability PartnershipNon-ProfitSole ProprietorshipState of Incorporation*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaNew BrunswickBritish ColumbiaManitobaNova ScotiaNewfoundland and LabradorOntarioPrince Edward IslandQuebecSaskatchewanBusiness Starting Date* MM slash DD slash YYYY Business Tax ID*Estimated Gross Annual Revenues*How do you currently find customers? Email Pay per click Social media Telephone Website Other Anticipated Number of Applications Monthly?*-- Select --1-23-55-1010+Do You Currently Offer Other Financing Solutions?*-- Select --YesNoTypes of financings you currently offer? CRE Financing Asset-Based Lending Specialty Finance Invoice Factoring Equipment Financing SBA Working Capital By submitting this application and entering your name below, you (i) confirm that the information provided is accurate and complete; (ii) authorize Number72 LLC (i95Capital.com) to verify your business information through available business verification services; (iii) consent to receiving calls and communications from Number72 LLC at the contact information provided above; (iv) agree to Number72 LLC's Terms and Conditions; and (v) confirm that you have read Number72 LLC's Privacy Policy.Applicant's Full Name*Date*
