Entity * ---CompanyIndividual
DBA
Last Name *
Phone Number *
Email *
Date of Birth (DOB) *
Physical Address *
City *
Country * ---United StatesCanada
Zip Code *
Website *
Mailing Address
Zip Code
Entity Type * ---Limited Liability CompanySole ProprietorshipCorporationPartnership
Tax ID Number (EIN) *
Office Phone Number *
(Total ownership must equal to 100%)
First Name *
Cell Phone
Home Address *
Role Type * ---OwnerDirectorManagerRepresentative
Ownership Percentage *
How did you hear about Greenbox Capital? * ---In Bank StatementsGoogle SearchFrom Another BrokerageDeBankedOther
What are you looking for in a lender? *
Do you receive submissions from outside agents or 3rd parties? * ---YesNo If yes, What percentage is from a 3rd party? * Do you fund your own deals? * ---YesNo What percentage of deals do you fund vs broker out? * ---0%-24%25%-49%50%-74%75%-100%
How does your company market to small business owners? *
Number of submissions we should expect each month? * ---0-2021-5050+
Number of monthly funded deals we should expect each month? * ---0-56-1515+
Dollar amount funded we should expect each month? * ---0-99,999$100,000-$299,000$300,000-$499,999$500,000 +
How many sales reps will sell our products? * ---1-56-1515-2930+
What other lenders do you currently work with? *
How many MCA positions do you fund your merchants? * ---12345+
Do you charge a broker/application fee? * ---YesNo
How much? *
Do you have a contact that you want copied on all correspondence? If so, please provide a name, email address and telephone: * ---YesNo
Please enter the email you would like to use for confirmation of funding and commission information. *
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