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Name:

First

Last

SSN:

Date Of Birth:

Estimated Credit Score:

Email:

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Company Name: DBA

EIN: (Or SSN)

Ownership Percentage:

Company Email:

Corporate Type

Gross Annual Revenue:

Company Address:

Address Line 1

Address Line 2

City

State

Zip Code

agree all in

Type Of Funding:

Equipment Finance
MCA
Line Of Credit
Term Loan

Amount Requested:

Anticipated Funding Date:

By checking this box, the applicant authorizes Omatori Capital, its partners, agents, banks, and affiliated financial institutions to obtain a consumer or investigative credit report from a credit bureau or reporting agency. The applicant also authorizes Omatori Capital to verify any information provided, including references and details from credit card processors, as needed to evaluate this application.

I Agree

I agree that by typing my name below, I am electronically signing this application. I consent to the use of electronic records and signatures in place of a handwritten signature. I confirm that all information provided is true and accurate to the best of my knowledge.

I Agree

E-Sign Name:

First

Middle

Last

Today's Date:

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