Request Funding

Business Funding Application

Capital for Business. Confidence for Growth.

Thank you for considering Whitlock Capital Group as your business funding partner. Our streamlined application allows us to understand your business, evaluate your funding needs, and identify potential financing solutions. Please complete the information below as accurately as possible. All information will be treated as confidential and used for evaluating your funding request.

Business Information

Legal Business Name *

DBA / Trade Name

Business Entity Type *

Business Address *

City *

State *

ZIP Code *

Business Phone *

Business Email *

Business Website

Industry / Business Type *

Date Business Established *

Federal EIN

Number of Business Locations

Funding Request

Requested Funding Amount *

How Will the Funding Be Used? *

Desired Funding Timeline *

Previously Received Business Funding? *

If Yes — Date of Most Recent Funding

Business Financial Information

Average Monthly Gross Revenue *

Average Monthly Credit Card Sales

Average Monthly Bank Deposits

Current Outstanding Business Advances or Loans

Number of Existing Financing Positions

Primary Business Bank

Business Bank Account Type

Business Owner Information

Primary owner information. For businesses with additional owners holding 20% or greater ownership, please note their details in the additional information field below.

Full Legal Name *

Title *

Ownership Percentage *

Date of Birth *

Residential Address *

City *

State *

ZIP Code *

Mobile Phone *

Email Address *

Required Documentation

Please be prepared to provide the following documents securely if requested:

—Most recent 3–6 months of business bank statements
—Merchant processing statements, if applicable
—Business voided check or bank verification
—Government-issued identification for business owners
—Additional business financial documentation, if required

Please do not submit sensitive financial documents through an unsecured website form. Whitlock Capital Group will provide a secure document submission method when needed.

Authorization & Acknowledgment

By submitting this application, I certify that the information provided is true, accurate, and complete to the best of my knowledge. I understand that submitting this application does not guarantee approval, an offer of financing, or funding. I authorize Whitlock Capital Group and its authorized financing partners, subject to applicable law and the separate disclosures and authorizations provided to me, to review the information submitted for the purpose of evaluating my business funding request.

Electronic Signature *

Printed Name *

Title *

A member of our team will review your submission and contact you regarding potential next steps.