Business Capital Application

Fill out this application form and be on your way to the funding you need.

Step 1 of 4 - Business Information

Business Details:
Legal Name of Business Entity*
Trade Name
Type of Entity*
Industry Type*
Country of Business Registration*
In what State is your business organized in?*
What Canadian Province is your business registered in?
Business Inception Date*
Federal Tax ID Number (FEIN)*
Website (URL):
Office Phone Number:
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is the above-listed property rented or owned by business?*

Management Information:
Your Legal Name*
First Last
Title/Role*
Company Ownership Percentage (%)*
Please enter a number from 0 to 100.
Mobile Phone Number*
We need to be able to reach you directly.
Email*
Date of Birth*
Social Security # (SSN)*
Primary Residence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Driver's License #:
Driver's License State
Driver's License Province
Passport #:
Issuing Country of Passport
What representative are you working with?*
How did you hear about us?*

Authorization*
I agree to this Credit Policy
By signing below, checking this box and submitting to us this Application Form, you certify that (i) you are authorized to apply on behalf of the Company, the full legal name of which appears above under the Company Information portion of this Application Form, for funding for business purposes and (ii) all information you provided on this Application Form and other supporting documents is true and complete and you will notify us of any material changes to such information.

You understand and agree that Capital Source Group (“CSG”) may disclose all information and documents that we may obtain about Company or you to other persons or entities including third-party financial institutions (“Third-Parties”). You understand and agree that we and Third-Parties, including our agents and assignees, are authorized to contact third parties to make inquiries in evaluating this Application Form about Company or you (including requesting business and personal credit bureau reports from credit reporting agencies and other sources) or for any update, renewal, extension of funding or other lawful purpose and consent to any such contact or inquiries. Upon your request, CSG will advise you if CSG obtained a credit report and will give you the credit bureau’s name and address. Furthermore, you hereby give CSG and Third-Parties, including any affiliate, permission to contact you at any phone number you provide on or in connection with this application, including via text messages.
Consent to Use of Electronic Records and Signatures (ESIGN Disclosure and Consent)*
I agree to this Disclosure
By signing below, you consent to receive any Communication, including any required disclosure, electronically and to the use of electronic signatures. Please review this ESIGN Disclosure and Consent carefully and keep a copy for your records.

In this consent:
 "We," "us," and "our" mean WebBank and Libertas Funding, LLC, including our service providers, agents, and affiliates.
 “You” and “your” means the business applicant and/or guarantor giving this consent.
 “Communication” means any disclosure, notice, agreement, document, statement, record, or other information that we provide to you, or that you submit to us.
 “Electronic Service” means each and every product and service we offer that you apply for, use, administer or access using the Internet, a website, email, messaging services (including text messaging) and/or software applications (including applications for mobile or hand-held devices), either now or in the future.
 “Product” means each and every account, product or service we offer that you apply for, own, use, administer or access, either now or in the future. Our Products include Electronic Services.
 The words “include" and "including," when used at the beginning of a list of one or more items, indicates that the list contains examples – the list is not exclusive or exhaustive, and the items in the list are only illustrations. They are not the only possible items that could appear in the list.

1. Your consent to use electronic records and signatures; Choosing to receive Communications electronically or in writing; Certain information may still be provided in writing
You agree that we may provide any Communication to you electronically (“Electronic Communications”) and to the use of electronic signatures.
Electronic Communications shall be delivered to you by email. You agree that we may contact you by e-mail, using any email address that you provide to us. In some cases, you
will be able to choose whether to receive certain Communications electronically, or on paper, or both. We will provide you with instructions on how to make those choices when they are available.
We may always, in our sole discretion, provide you with any Communication via paper, even if you have chosen to receive it electronically.
Any notice you are required to provide to us by law, agreement, or otherwise must still be provided to us on paper; unless we specifically tell you in another Communication how
you may deliver that notice to us electronically.

2. Your option to receive paper copies
If we provide Electronic Records to you and you want a paper copy, you may contact us at (800) 704-8675 or customer.service@libertasfunding.comand request a paper version.

3. Your consent covers all Products by or through Libertas
Your consent covers all Communications relating to any Product offered by or though us. Your consent remains in effect until you give us notice that you are withdrawing it. From time to time, you may seek to obtain a new Product. When you do, we may remind you that you have already given us your consent to use Electronic Records and signatures. If you decide not to use Electronic Records and signatures in connection with the new product or service, your decision does not mean you have withdrawn this
consent for any other Product.

4. You may withdraw your consent at any time; Consequences of withdrawing consent; How to give notice of withdrawal
You have the right to withdraw your consent at any time. Please be aware, however, that withdrawal of consent may result in the termination of your access to our Electronic
Services, including online account access, and your ability to use certain Products.
To withdraw your consent, you must contact us at (800) 704-8675 or email us at customer.service@libertasfunding.com. Your withdrawal of consent will become effective after
we have had a reasonable opportunity to act upon it.

5. You must keep your email or electronic address current with us.
It is your responsibility to keep your primary email address current so that we can communicate with you electronically. You must promptly call us at (800) 704-8675 or email us
at customer.service@libertasfunding.com to notify us any change in your email or other electronic address. You understand and agree that if we send you a Communication
but you do not receive it because your primary email address on file is incorrect, out of date, blocked by your service provider or you are otherwise unable to receive electronic Communications, we will be deemed to have provided the Communication to you. If you use a spam filter or similar software that blocks or re-routes emails from senders not listed in your email address book, we recommend that you add us to your email address book so that you can receive Communications by e-mail.

6. Necessary Hardware and Software
To receive access and retain Electronic Communications, you must have:
• A valid email address;
• Sufficient electronic storage capacity;
• An internet browser, with software for viewing documents such as Portable Document Format (PDF) and other images that supports Secure Sockets Layer (SSL) 256 bit encryption;
• Internet connectivity capable of sending, receiving and accessing data, information and communications from us; and
• either a printer, a hard drive or other storage device.
(Your access to and signing of this Disclosure and Consent verifies that your browser and encryption software/device meet the above requirements.)
7. Changes to hardware or software requirements
If our hardware or software requirements change and that change would create a material risk that you would not be able to access or retain Electronic Communications, we will give you notice of the revised hardware or software requirements. Your continued use of Electronic Services after receiving notice of the change is reaffirmation of your consent.

8. Federal Law
You acknowledge and agree that you affirmatively consent to do business electronically and that you and we both intend that the Electronic Signatures in Global and National Commerce Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.
By providing your consent, you are also confirming that you have the hardware and software described above, that you are able to receive and review Electronic Records, and that you have a valid email account. You are also confirming that you are authorized to, and do, consent on behalf of the applicant.
Examples of electronic records covered by your consent include:
• This ESIGN Consent and any amendments;
• Other service or user agreements for online access to our Electronic Services, and all amendments to any of these agreements;
• All of the Communications related to any Product, except for those excluded by the terms of this ESIGN Consent;
• Any and all periodic account and activity statements, disclosures and notices we provide to you concerning your Products;
• Any notice or disclosure regarding fees or assessments of any kind, including late fees, overdraft fees, over limit fees, and returned item fees;
• Notices of amendments to any of your agreements and accounts with us; and
• Other disclosures and notices that we are legally required to provide to you or choose to provide to you in our discretion.
Signature*
Phone
This field is for validation purposes and should be left unchanged.

Business Capital Application

Step 1 of 4 - Business Information

Business Details:

Financial Information:

Management Information: