Business Financing Apply

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    Business Information

    Type of Entity *

    CorporationLPGeneral PartnershipSole PropLLCS CropLLPOther

    Legal Business Name *

    DBA *

    Address *

    City

    State

    Postal/Zip Code

    Federal Tax ID *

    Business Start Date *

    Phone

    Fax

    Email

    Website

    Industry Type *

    [cf7mls_step cf7mls_step-508]

    Owner Information


    Owner First & Last Name *

    Ownership % *

    Address *

    City

    State

    Postal/Zip Code

    Phone

    Mobile

    Date of Birth *

    Social Security # *

    [group group-981]

    Owner #2 Information

    Owner First & Last Name *

    Ownership % *

    Address *

    City

    State

    Postal/Zip Code

    Phone

    Mobile

    Date of Birth *

    Social Security # *

    [/group]
    [group group-486]

    Owner #2 Information

    Owner First & Last Name *

    Ownership % *

    Address *

    City

    State

    Postal/Zip Code

    Phone

    Mobile

    Date of Birth *

    Social Security # *

    Owner #3 Information

    Owner First & Last Name*

    Ownership % *

    Address *

    City

    State

    Postal/Zip Code

    Phone

    Mobile

    Date of Birth *

    Social Security # *

    [/group]

    [cf7mls_step cf7mls_step-265]

    Revenue

    Monthly Credit Card Sales *

    Monthly Gross Sales *

    Gross Annual Sales *

    Amount Requested *

    Use of Funds *

    [cf7mls_step cf7mls_step-851]

    Do you have an existing advance


    [group group-91]

    Existing Advance

    Funding Amount*

    Balance *

    Days/Months Remaining *

    Funding Company *

    Funding Date*

    Daily Payment / Holdback % *

    [group group-197]

    Existing Advance #2

    Funding Amount*

    Balance *

    Days/Months Remaining *

    Funding Company *

    Funding Date*

    Daily Payment / Holdback % *

    [/group]
    [group group-198]

    Existing Advance #2

    Funding Amount*

    Balance *

    Days/Months Remaining *

    Funding Company *

    Funding Date*

    Daily Industry Type / Holdback % *

    Existing Advance #3

    Funding Amount*

    Balance *

    Days/Months Remaining *

    Funding Company *

    Funding Date*

    Daily Payment / Holdback % *

    [/group]
    [/group]

    [cf7mls_step cf7mls_step-593]

    Property Information

    Type of Property

    OwnLeaseHome Based

    Landlord Contact Name

    Rent / Mortgage Amount

    Contact Phone #

    Contact E-mail

    Questions

    Any Pending Claims, Judgments, Tax Liens, or Bankruptcies? *
    NoYes, Please Explain Below

    [group group-954]


    [/group]

    Applicant(s) authorizes Regis Capital Group and its assigns, agents, banks or financial institutions to obtain an investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant. A non-refundable application fee of $495.00 will be charged should application be approved for funding. Applicant hereby authorizes Regis Capital Group, LLC and its affiliates to electronically draft via the Automated Clearing House system all its related fees stated herein. The Undersigned hereby certifies that they are duly authorized to execute this form on behalf of the above listed account holder.

    • Signature *

    • [group group-719]

      Signature *

      [/group]

    • [group group-222]

      Signature *

      [/group]

    Date Time *

    04/10/2025 , 06:40

    Last 3 Months of Bank Statements

    Bank Statement #1*

    Upload File

    Bank Statement #2*

    Upload File

    Bank Statement #3*

    Upload File

    ID*

    Upload File

    Voided Check*

    Upload File

    [recaptcha class:google_cap]


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    jQueryinput = jQuery(''),
    // Button that will be used in non-IE browsers
    jQuerybutton = jQuery(''),
    // Hack for IE
    jQuerylabel = jQuery('');

    // Hide by shifting to the left so we
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    jQueryfile.css({
    position: 'absolute',
    left: '-9999px'
    });

    jQuerywrap.insertAfter( jQueryfile )
    .append( jQueryfile, jQueryinput, ( isIE ? jQuerylabel : jQuerybutton ) );

    // Prevent focus
    jQueryfile.attr('tabIndex', -1);
    jQuerybutton.attr('tabIndex', -1);

    jQuerybutton.click(function () {
    jQueryfile.focus().click(); // Open dialog
    });

    jQueryfile.change(function() {

    var files = [], fileArr, filename;

    // If multiple is supported then extract
    // all filenames from the file array
    if ( multipleSupport ) {
    fileArr = jQueryfile[0].files;
    for ( var i = 0, len = fileArr.length; i < len; i++ ) {
    files.push( fileArr[i].name );
    }
    filename = files.join(', ');

    // If not supported then just take the value
    // and remove the path to just show the filename
    } else {
    filename = jQueryfile.val().split('\\').pop();
    }

    jQueryinput.val( filename ) // Set the value
    .attr('title', filename) // Show filename in title tootlip
    .focus(); // Regain focus

    });

    jQueryinput.on({
    blur: function() { jQueryfile.trigger('blur'); },
    keydown: function( e ) {
    if ( e.which === 13 ) { // Enter
    if ( !isIE ) { jQueryfile.trigger('click'); }
    } else if ( e.which === 8 || e.which === 46 ) { // Backspace & Del
    // On some browsers the value is read-only
    // with this trick we remove the old input and add
    // a clean clone with all the original events attached
    jQueryfile.replaceWith( jQueryfile = jQueryfile.clone( true ) );
    jQueryfile.trigger('change');
    jQueryinput.val('');
    } else if ( e.which === 9 ){ // TAB
    return;
    } else { // All other keys
    return false;
    }
    }
    });

    });

    };

    // Old browser fallback
    if ( !multipleSupport ) {
    jQuery( document ).on('change', 'input.customfile', function() {

    var jQuerythis = jQuery(this),
    // Create a unique ID so we
    // can attach the label to the input
    uniqId = 'customfile_'+ (new Date()).getTime(),
    jQuerywrap = jQuerythis.parent(),

    // Filter empty input
    jQueryinputs = jQuerywrap.siblings().find('.file-upload-input')
    .filter(function(){ return !this.value }),

    jQueryfile = jQuery('');

    // 1ms timeout so it runs after all other events
    // that modify the value have triggered
    setTimeout(function() {
    // Add a new input
    if ( jQuerythis.val() ) {
    // Check for empty fields to prevent
    // creating new inputs when changing files
    if ( !jQueryinputs.length ) {
    jQuerywrap.after( jQueryfile );
    jQueryfile.customFile();
    }
    // Remove and reorganize inputs
    } else {
    jQueryinputs.parent().remove();
    // Move the input so it's always last on the list
    jQuerywrap.appendTo( jQuerywrap.parent() );
    jQuerywrap.find('input').focus();
    }
    }, 1);

    });
    }

    }(jQuery));

    jQuery('input[type=file]').customFile();