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My Current Position is as follows: *
Check all that apply - No Up Front Fees!
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Funds Needed are as follows: *
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Full Legal Name: *
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Date Of Birth: *
Your answer
Home Phone Number: *
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Cell: *
Your answer
Email: *
Your answer
Social Security Number: *
Your answer
Home Street Address: (no PO boxes) *
Your answer
City - State and Zip Code: *
Enter Funding Amount
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Experian - Equifax - Trans Union Scores: Enter all 3 *
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Business or Job Name: *
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Business or Work Phone Number: *
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Business or Job - Street Address - (no PO boxes) *
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Business or Job - City - State and Zip Code: *
Your answer
Type Of Business or Type of Job: *
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Check which applies: *
Required
Owner Name: *
Your answer
Title: *
Your answer
Ownership Percentage % or W2 Wage Earner: *
Your answer
EIN # or SS# if Personal Loan: *
Your answer
2017 Business or Personal Tax Return Gross Amount: *
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2017 Business or Personal Tax Return Net Amount: *
Your answer
Year To Date Gross: *
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Year To Date Net: *
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Last 3 Month's Bank Deposit Amounts: *
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Existing Personal or Business Debt: Check all that apply *
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Established Personal or Business Credit? *
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By signing below, each of the above listed Business Owner(s)/Officer(s)/Principal(s) and Business (individually and collectively, “You”) certify that all information and documents submitted in connection with this Funding Application ("Application") are accurate, true, correct and complete; and that You will immediately notify us at 516-847-2209 MotherGoddessEarth.com a partner of (“DC”) or any of its representatives, successors, assigns, designees, agents, partners or affiliates ("Recipients") of any change in such information or financial condition. You further authorize MGE/DC or successors- and- assigns to obtain consumer or personal, business and investigative reports and other information about You, including, but not limited to credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, financial institutions, creditors and other third parties. You also authorize MGE/DC to transmit this Application, along with any of the foregoing information obtained in connection with this Application, to any or all of the Recipients for the foregoing purposes. *
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Enter "I Agree" that all information submitted here is true and accurate to the best of my knowledge. *
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Enter Electronic Signature: *
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Enter Title and Authorization to commence processing and preparation for a Loan: I Authorize MGE/DC to begin the Loan process: Enter "I Authorize Now" *
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Comments - Special Requests - Acknowledgments - This form is secure and goes directly to Management team approved as a partner of the bank and affiliate lending institutions in our closed network. This information is not shared with any outside third party for any reason. In network files are reviewed by us and matched to the appropriate lender in our closed network. All information entered remains strictly confidential. You can enter additional comments or requests in the space below. One of our representatives will be in touch with you at the contact numbers listed within 48 hours or less. Our contact information is available to you upon clicking "submit".
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