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Fields marked with an asterisk are required.

Business Information

The basics about the business applying for funding.

Legal Business Name

DBA / Trade Name (optional)

Entity Type

EIN / Federal Tax ID

Type of Business / Industry

Business Start Date

Street Address

City

State

ZIP

Business Phone

Business Email

Funding Amount Requested

How much you’re looking for. Most requests fall between $5,000 and $250,000.

Website (optional)

Existing Funding

This helps us understand the business’s current obligations.

Does the business currently have an outstanding merchant cash advance, ACH-based funding, commercial financing, or commercial mortgage?

Yes No

Owner Information

Owner 1 — Primary. Personal details are used for identity verification and credit review.

Owner 1· Primary

Full Legal Name

Ownership Percentage

Personal Phone

Personal Email

Date of Birth

Social Security Number

Used for identity verification and credit review.

Estimated Credit Score

Self-reported estimate — no credit is pulled when you submit this form.

Home Street Address

City

State

ZIP

Additional Owners (optional)

Add any other owners of the business — up to 4 owners total. The form submits with Owner 1 alone.

Bank Statements

Upload the last three months of business bank statements — all pages, downloaded as PDFs from online banking.

Optional — you can also email them to info@leverupliquidity.com after you apply.

Drag and drop your statements hereChoose your statements

PDF, JPG, PNG, HEIC or WEBP · up to 5 MB per file · 25 MB total · 12 files max

Authorization & Consent

Please review and agree to both authorizations.

Credit AuthorizationEach owner listed above authorizes Leverup Liquidity and its funding partners to obtain consumer credit reports and credit scores for the purpose of evaluating this application, in accordance with the Fair Credit Reporting Act.

Personal Guaranty AcknowledgmentEach owner acknowledges that any funding obtained may require a personal guaranty, and certifies that all information provided in this application is true, accurate, and complete.

By submitting this application, you certify that the information provided is true and complete.

1Business Information

2Existing Funding

3Owner Information

Owner 1· Primary

4Additional Owners (optional)

Owner __N__

5Bank Statements

6Authorization & Consent