Step 1 of 5
Please fill out your business information in the fields provided.
What is your business's name and type?
Select Business TypeAdult EntertainmentAdvertising ServicesAgriculture/LandscapingApparel/ AccessoriesAuction HouseAutomotive/ BicycleBeauty/ Hair/ Nail SalonBuilding MaterialsBusiness ServicesCannabisConstruction/ ContractorsEducation/ School/ TutorElectronics/ Computer RepairEnergy/ FuelsFirearmsGamblingGardening/ NurseryGeneral MerchandiseGrocery/ Baked GoodsHealthcareHealth ServicesHome/ Office CleanersHome Furnishing/ FurnitureHospitalityInsurance/ FinanceLaundry/ GarmentLegal ServicesManufacturingPhotographyReal EstateRecreationReligious OrganizationsRestaurant/ Café/ Bar/ Lounge/ Food ServicesRetail StoreSecurity/ Private DetectiveTransportation/ TruckingTravel/ TourismVeterinary Clinic/ Pet ServicesWholesaleOther
Select Legal EntityCorpLLCSole PropPublicOtherPartnership
Address and Contact
StateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Additional Business Information
Landlord/Rent/Mortgage Info
Do you currently own other assets?
Asset type
Est. value ($)
Debt owed ($)
Select asset typeCommercial real estateResidential real estateEquipment / machineryVehicles / fleetInventoryOther
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Step 2 of 5
Let us know how much you want to grow your business.
How much would you like and how much do you earn?
Do you have any current Business Loan Balances?
Select OneNoYes
What will the use of funds be?
Select OnePurchase Inventory/SuppliesEquipment/TechnologyMarketing CampaignExpansion/HiringDebt Consolidation/PayoffReduce Accounts PayableCash Crunch/PayrollRenovations/RepairsWorking CapitalOther
Step 3 of 5
Tell us about you, and any other co-owners of your business.
What's your name?
Your Address
Contact Details
Additional Info
Add another Owner
Remove this Owner
Step 4 of 5
You're almost there. Just attach a few documents we need.
Please attach the following documents to get started: (Hint: 76% of those who upload bank statements receive funding. However, no worries if you don’t have them now, we can discuss during your free consultation.)
Bank statements (last 3 months, 4 months if located in California or New York)
Step 5 of 5
Last step! Just sign your name(s) and we're good to go.
Please use your mouse to sign.
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Owner 1 Signature
Owner 2 Signature
Owner 3 Signature
I acknowledge and agree to the below Terms of Acceptance.
I, on behalf of myself, the Merchant, and its owners/principals, acknowledge and agree to the below Terms of Acceptance.
By signing this Application, the Merchant and its owners/principals: (1) certify that all information and documents submitted in connection with this Application are true, correct and complete; and (2) authorize United Capital Source Inc., its agents, partners, affiliates and lenders to perform the credit and background investigation necessary and any other information regarding the Merchant and its owners and principals from third parties, to verify any information provided in connection with the Application. I am authorized by all necessary parties (including the Merchant, its owners, and its principals) to agree to these terms on their behalf.
Merchant and its owners/principals verify the accuracy of the telephone numbers and email addresses provided in connection with this Application, and consent to receive telephone calls and text messages, including by automated technology (including auto-dialing or prerecording), regarding products and services offered by, through, or on behalf of United Capital Source, Inc. or its affiliates. This consent is effective even if the number(s) are registered on a federal or state Do-Not-Call list. Merchant and its owners/principals consent to receive emails to the email addresses provided on this Application, regarding products and services offered by, through, or on behalf of United Capital Source or its affiliates. No purchase or completed transaction is required. Message and data rates may apply. To opt out at any time please email [email protected].
I acknowledge and agree to the below SMS Terms.
By checking this box, I consent to receive account notifications SMS messages from United Capital Source Inc. You can reply "STOP" at anytime to opt-out. Message and data rates may apply. Message frequency may vary, text HELP for assistance. For more information, please visit our Privacy Policy and Terms of Service
