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NamePhone NumberEmailLoan Amount RequestedHow will you use the funds? (hold ctrl (windows) or cmd (mac) to select multiple)Business IndustryPersonal Credit ScoreWhat year did the business start?How much revenue has the business made over the past 12 months (including owner W2)?Please select all that apply.Have a prior bankruptcyOperate as a franchiseInvoice CustomersOperate as a non-profitUS Citizen or Green Card HolderHave a tax lien (federal, state, or otherwise)Currently have any charged off accountsAm involved in a pending/active lawsuit (personal or business)What percentage of the business do you own?What state is your business in?Business Entity TypePersonal Outside Income (spouse income, retirement, social security, pension, other W2 income not from the subject business)I agree to the Terms of Application, Terms of Use which includes an arbitration agreement, Credit Authorization, E-sign Disclosure, and Privacy Policy.By checking this box and clicking "Submit", I consent to receive recorded marketing phone calls (both human and artificial intelligence) and/or text messages from CX Lending, including autodialed and pre-recorded calls delivered using automated means. I acknowledge consent is not a condition of purchase or submission and I may opt out at any time.

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