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Application
Submission For
See Your Loan Options for Free
First Name:
Last Name:
Email:
Phone:
Legal Company Name:
Business DBA Name:
About You
First Name:
Last Name:
Mobile Phone:
Owner Email:
Your Address:
Date of Birth
FICO Score
Social Security Number:
Do you own at least 51%?
Ownership %:
Signature Owner 1
Co-Owner
First Name:
Last Name:
Mobile Phone:
Co-Owner Email:
Your Address:
Date of Birth
FICO Score
Social Security Number:
Do you own at least 51%?
Ownership %:
Signature Owner 2
Each of the undersigned, who is either a Principal, Sole Proprietor or Personal Guarantor of the above-named business, recognizes that his or her individual credit history may be a factor in the evaluation of this application of the above named business for funding. Each of the undersigned hereby authorizes Roth Wealth Holdings and its assigns and/or affiliate partners of Roth Wealth Holdings to obtain his or her credit report (and any updates to his or her credit report) in connection with Roth Wealth Holdings consideration of this application and any affiliate partners of Roth Wealth Holdings in connection with any subsequent review of the account of the abovenamed business. Each of the undersigned hereby authorizes Roth Wealth Holdings to utilize information including but not limited to calls, emails, texts and direct mail for marketing efforts from Roth Wealth Holdings.
Business Details
Legal Company Name:
Business DBA Name:
Company Tax ID:
Business Address:
Business Phone Number:
Desired Loan Amount
Time In Business:
Annual Revenue
Utilization of Funds:
Business Start Date:
Monthly Revenue:
Company Type:
Nature of Business
Qualifying Questions
Any open Liens or Judgments?
Did you ever default on a cash advance?
Have you applied for the ERC Grant?
Was your business established no later than 2019?
Did you have less than 500 W-2 Employees in 2020?
Number of W-2 Employees in 2020:
Ever filed for bankruptcy?
Please specify bankruptcy year:
Please specify bankruptcy status:
Do you currently have a cash advance?
Do you have any collateral?
Cash Advance Info
Position #
Lender Name:
Frequency:
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Current Balance:
Payment Amount
Payments(s) Left
Equity Advance Info
Property #
Property Address:
Asset Type:
Year Acquired:
Purchase Price:
Current Price:
Loan Balance:
Lender(s):
Lien(s):
Creditor(s):
Title Holder(s)
Upload Statements
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August, 2024
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September, 2024
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October, 2024
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November, 2024
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December, 2024 To Date
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