Logo Block Equity Group

Loan Amount

Value must be greater than zero.

Business Information

Please enter the legal name of the business.
Business Physical Address
Please enter the physical address of the business.
Please enter the city the business is located in.
Please select the state the business is located in.
Please enter the 5 digit ZIP/postal code for the business address.
Please enter a valid phone number.
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Please input a valid FEIN.
Please input a valid date.
Please select the State of incorporation.
Value must be greater than zero.
Value must be greater than zero.
Please select a valid industry.
Please select a valid entity type.

Owner Details

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Additional Business Information

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Mailing Address (Optional)
Please enter the mailing address of the business.
Please enter a valid city.
Please select a valid state.
Please enter a valid 5 digit ZIP/postal code.
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Value must be greater than zero.
Value must be greater than zero.
Please enter a valid description.
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Please enter a valid number.
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Applicant Information

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Value must be greater than zero.
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Compliance Information

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Required Documents

Signature and Agreement

Please provide a signature.

By signing above, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize Block Equity Group. and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily/or other repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, “Transactions”) to obtain consumer and/or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as Transunion, Experian, Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Block Equity Group to transmit this application form, with any of the foregoing information obtained in connection with this application, to any or all of the Receipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to Block Equity Group and to each of the Recipients, on its own behalf. I am providing my business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding transactions with Block Equity Group and/or its affiliates on either medium. I also hereby consent to the receipt of text messages knowing messages and data rates may apply. I understand that consent to receive texts is not a condition of approval. I can expect approximately 10 messages/month. I/we certify that all the information contained herein is complete, true and accurate.