Clemy Jajati – Funding Application Fill out the application below | Upload your last 4 months business bank statements | Sign and submit the form Clemy Jajati Clemy@ThorCapitalGroup.com 347-416-0664 "*" indicates required fields Business InformationLegal/Corporate Name* DBA (if any) Business Address* Physical Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Business Email* Website Federal Tax ID* Date Business Started* MM slash DD slash YYYY Length of Ownership*Under 1 Year1-2 Years3-5 Years5+ YearsType of Entity*Limited Liability Corporation (LLC)Sole ProprietorshipC-CorporationS-CorporationGeneral PartnershipLimited Liability PartnershipIndependent Contractor (1099)OtherState of Organization*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingIndustry*AccountingAirlines/AviationAlternative Dispute ResolutionAlternative MedicineAnimationApparel & FashionArchitecture & PlanningArts and CraftsAutomotiveAviation & AerospaceBankingBiotechnologyBroadcast MediaBuilding MaterialsBusiness Supplies and EquipmentCapital MarketsChemicalsCivic & Social OrganizationCivil EngineeringCommercial Real EstateComputer & Network SecurityComputer GamesComputer HardwareComputer NetworkingComputer SoftwareInternetConstructionConsumer ElectronicsConsumer GoodsConsumer ServicesCosmeticsDairyDefense & SpaceDesignEducation ManagementE-LearningElectrical/Electronic ManufacturingEntertainmentEnvironmental ServicesEvents ServicesExecutive OfficeFacilities ServicesFarmingFinancial ServicesFine ArtFisheryFood & BeveragesFood ProductionFund-RaisingFurnitureGambling & CasinosGlass, Ceramics & ConcreteGovernment AdministrationGovernment RelationsGraphic DesignHealth, Wellness and FitnessHigher EducationHospital & Health CareHospitalityHuman ResourcesImport and ExportIndividual & Family ServicesIndustrial AutomationInformation ServicesInformation Technology and ServicesInsuranceInternational AffairsInternational Trade and DevelopmentInvestment BankingInvestment ManagementJudiciaryLaw EnforcementLaw PracticeLegal ServicesLegislative OfficeLeisure, Travel & TourismLibrariesLogistics and Supply ChainLuxury Goods & JewelryMachineryManagement ConsultingMaritimeMarket ResearchMarketing and AdvertisingMechanical or Industrial EngineeringMedia ProductionMedical DevicesMedical PracticeMental Health CareMilitaryMining & MetalsMotion Pictures and FilmMuseums and InstitutionsMusicNanotechnologyNewspapersNon-Profit Organization ManagementOil & EnergyOnline MediaOtherOutsourcing/OffshoringPackage/Freight DeliveryPackaging and ContainersPaper & Forest ProductsPerforming ArtsPharmaceuticalsPhilanthropyPhotographyPlasticsPolitical OrganizationPrimary/Secondary EducationPrintingProfessional Training & CoachingProgram DevelopmentPublic PolicyPublic Relations and CommunicationsPublic SafetyPublishingRailroad ManufactureRanchingReal EstateRecreational Facilities and ServicesReligious InstitutionsRenewables & EnvironmentResearchRestaurantsRetailSecurity and InvestigationsSemiconductorsShipbuildingSporting GoodsSportsStaffing and RecruitingSupermarketsTelecommunicationsTextilesThink TanksTobaccoTranslation and LocalizationTransportation/Trucking/RailroadUtilitiesVenture Capital & Private EquityVeterinaryWarehousingWholesaleWine and SpiritsWirelessWriting and EditingOtherDetailed Business Activity* Primary Owner InformationCorporate Officer/Owner Name* First Last Title* Ownership Percentage*Select your Ownership Percentage100999897969594939291908988878685848382818079787776757473727170696867666564636261605958575655545352515049484746454443424140393837363534333231302928272625242322212019181716151413121110987654321Email* Home PhoneCell Phone*SSN* Date of Birth* MM slash DD slash YYYY Credit Score? Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Add Partner Add Partner Partner Information 1Name* First Last Title Ownership Percentage 1*Select your Ownership Percentage100999897969594939291908988878685848382818079787776757473727170696867666564636261605958575655545352515049484746454443424140393837363534333231302928272625242322212019181716151413121110987654321Email* PhoneCell Phone*SSN* Date of Birth* MM slash DD slash YYYY Credit score? Home Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property InformationDo you...?* Rent Own How much is rent?*Business Core InformationAny Open Judgements?* Yes No Any Bankruptcies?* Yes No Any Tax Liens?* Yes No Is Business Seasonal?* Yes No Which month(s) are the busiest?* January February March April May June July August September October November December FinancialsDo you accept Credit Cards?* Yes No Number of Terminals*Avg Monthly Gross Sales Volume?*Requested Funding Amount*What will funds be used for?* Are you currently paying off any loans or advance(s)?* Yes No Lender Name* Loan/Advance Amount*How did you hear about us?*GoogleEmailReferralLinkedInOtherPlease specify* Signature & ConsentPrimary Owner Signature*Partner Signature*HiddenSalesperson Please upload recent bank statements. Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 10 MB. Please wait until your attachment is FULLY uploaded.Consent*By clicking the “Get Funded” button immediately following this notice, you are providing “written instructions” to Thor Capital Group LLC and/or its corporate affiliates under the Fair Credit Reporting Act authorizing Thor Capital Group LLC to obtain information from your personal credit profile or other information from a consumer reporting agency. You authorize Thor Capital Group LLC to obtain such information solely to conduct a pre-qualification for credit. You also understand that by clicking on the “Get Funded” button, you authorize Thor Capital Group LLC and prospective third-party funding providers to contact you at the numbers you provide (including mobile) during any step of this application, via phone (including automated telephone dialing systems, prerecorded, SMS and MMS means) even if you are on a Do Not Call Registry. You are not required to agree to be contacted in this manner to use Thor Capital Group LLC services. More information can be found in our privacy policy here. I agree to the terms and conditions of this application, and affirm everything is true.HiddenToday's Date MM slash DD slash YYYY Δ
