[docusign_form multistep=true][row][col size=12 id=”personal2″ ][docusign_form_step] [docusign_step_tab label=”Business Information” id=”personal” class=”active” icon=”ri-lock-unlock-line text-primary”] [docusign_step_tab label=”Owner Information” id=”contact” icon=”ri-user-fill text-danger”] [docusign_step_tab label=”Owner/ Partner Information” id=”contact” icon=”ri-user-fill text-danger”] [docusign_step_tab label=”Processing Information” id=”contact” icon=”ri-user-fill text-danger”] [/docusign_form_step] [/col] [col size=12 id=”docusign-form-field”] [docusign_step_body label=”Business Information” button=1] [docusign_text_field label=”Legal Corporation Name*” tab_label=”legal_corporation_name” placeholder=”” required=”true”] [docusign_text_field label=”DBA name” tab_label=”dba_name” placeholder=”” ] [docusign_text_field label=”Physical address*” tab_label=”physical_address” placeholder=”” required=”true”] [docusign_text_field label=”City,State, Zip Code*” tab_label=”city_state_zip” required=”true”] [docusign_text_field label=”Entity Corp/LLC/Sole Prop*” tab_label=”entity_crop_llc_sole_prop” required=”true”] [docusign_text_field label=”Telephone number*” tab_label=”telephone_number” placeholder=”000-000-0000″ required=true ] [docusign_text_field label=”Tax id*” tab_label=”tax_id” required=”true”] [docusign_email_field label=”Email*” tab_label=”email” required=true] [docusign_text_field label=”Website” tab_label=”website” ] [docusign_text_field label=”Length of ownership*” tab_label=”length_of_ownership” required=”true”] [docusign_text_field label=”Nature of business” tab_label=”nature_of_business” ] [docusign_text_field label=”# Of Locations” tab_label=”#_of_locations” ] [docusign_text_field label=”Products service sold” tab_label=”products_service_sold” ] [docusign_text_field label=”Owner Name*” tab_label=”owner_owner_name” required=true][recaptcha/]Page : 1 of 4 [/docusign_step_body] [docusign_step_body label=”Owner Information” ] [docusign_text_field label=”Owner title” tab_label=”owner_title” ] [docusign_select_field label=”Seasonal business” tab_label=”seasonal_business” value=”Yes,No”] [docusign_select_field label=”Tax liens” tab_label=”tax_liens” value=”Yes,No”] [docusign_select_field label=”Is the business for sale” tab_label=”is_the_business_for_sale” value=”Yes,No”] [docusign_select_field label=”Currently in bankruptcy?” tab_label=”currently_in_bankruptcy” value=”Yes,No”] [docusign_select_field label=”Discharged bankruptcy in last 7 years?” tab_label=”discharged_bankruptcy_in_last_7_years”  value=”Yes,No”] [docusign_select_field label=”Are you in a cash advance now?*” tab_label=”are_you_in_a_cash_advance_now” value=”Yes,No”] [docusign_text_field label=”Notes (For Cash Advance Balances And Company Names)” tab_label=”notes” ] [docusign_number_field label=”Requested funding amount ‘$'” tab_label=”requested_funding_amount” ] [docusign_text_field label=”What will funds be used for” tab_label=”what_will_funds_be_used_for” ] [docusign_number_field label=”Number of employees” tab_label=”number_of_employees” ] [docusign_select_field label=”Own rent business location” tab_label=”own_rent_business_location” value=”Own,Rent”] [docusign_text_field label=”Time remaining on lease” tab_label=”time_remaining_on_lease” ] [docusign_text_field label=”Business Landlord Name ” tab_label=”business_landlord” ] [docusign_text_field label=”Landlord Phone” tab_label=”phone” placeholder=”000-000-0000″ ] [docusign_select_field label=”Any pending legal actions or claims?” tab_label=”any_pending_legal_actions_or_claims” value=”Yes,No”] [docusign_number_field label=”Monthly rent amount ‘$'” tab_label=”monthly_rent_amount” ] [docusign_select_field label=”Ownership % *” tab_label=”owner_ownership_percent” required=”true” first_blank=”Select Percentage” value=”1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100″] [docusign_text_field label=”Home Address*” tab_label=”owner_home_address” required=”true”] [docusign_text_field label=”City, State, Zip*” tab_label=”owner_city-state_zip” required=”true”] [docusign_text_field label=”Owner ssn*” tab_label=”owner_ssn” required=”true”] [docusign_date_field label=”Owner DOB*” tab_label=”owner_dob” required=”true”] [docusign_text_field label=”Owner home phone” tab_label=”owner_home_phone” placeholder=”000-000-0000″] [docusign_number_field label=”Owner cell” tab_label=”owner_cell” ] [docusign_select_field label=”Do you own or rent your residence?” tab_label=”owner_do_you_own_or_rent_your_residence” value=”Own,Rent”] [docusign_text_field label=”Driver License #” tab_label=”owner_drivers_license” ] [docusign_text_field label=”State Issued” tab_label=”owner_state_issued” ] Page : 2 of 4 [/docusign_step_body] [docusign_step_body label=”Owner/ Partner Information” ] [docusign_text_field label=”Owner name” tab_label=”owner_name” ] [docusign_text_field label=”title” tab_label=”title” ] [docusign_number_field label=”Ownership %” tab_label=”ownership_partner” ] [docusign_text_field label=”Home address” tab_label=”home_address” ] [docusign_text_field label=”City,State, Zip Code” tab_label=”city-state_zip” ] [docusign_text_field label=”SSN” tab_label=”ssn” ] [docusign_date_field label=”Date of Birth” tab_label=”dob” ] [docusign_text_field label=”Home phone” tab_label=”partner_home_phone” placeholder=”000-000-0000″ ] [docusign_text_field label=”Cell” tab_label=”partner_cell” placeholder=”000-000-0000″ ] [docusign_select_field label=”Do you own or rent your residence?” tab_label=”partner_do_you_own_or_rent_your_residence” value=”Own,Rent”] [docusign_text_field label=”Drivers license” tab_label=”partner_drivers_license” ] [docusign_text_field label=”State issued” tab_label=”partner_state_issued” ] Page : 3 of 4 [/docusign_step_body] [docusign_step_body next_text=”SUBMIT” label=”Processing Information” submit=true] Do you accept cards [docusign_checkbox_field label=”Visa” tab_label=”visa” ] [docusign_checkbox_field label=”Visa Debit” tab_label=”visa_debit” ] [docusign_checkbox_field label=”Mastercard” tab_label=”Mastercard” ] [docusign_checkbox_field label=”Discover” tab_label=”Discover” ] [docusign_checkbox_field label=”AMEX” tab_label=”AMEX” ] [docusign_checkbox_field label=”Pinpad debit” tab_label=”pinpad_debit” ] [docusign_number_field label=”Monthly card volume” tab_label=”monthly_card_volume” ][docusign_number_field label=”Number of terminals” tab_label=”number_of_terminals” ] [docusign_text_field label=”POS version” tab_label=”pos_version” ] [docusign_text_field label=”High ticket” tab_label=”high_ticket” ] Page : 4 of 4 [/docusign_step_body] [/col][/row][/docusign_form]