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Application

Legal Name of Entity*
Type of Entity*
Partnership*
Federal Tax ID*
Date of Incorporation*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Amount Needed*

Name*
First Last
Cell Phone Number*
Email*
Date of Birth*
Social Security #*
Ownership %*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How did you hear about us?*

Signature*
Authorization*
- By signing above and checking this box, you authorize Segway Financial, LLC (“Segway”) and each of its agents including Commercial Financing Institutions (“Partners”) to obtain consumer or personal, business and investigative reports and other information about you and your business from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Segway to transmit this application form, along with any of the foregoing information obtained in connection with this application (including but not limited to credit card processor statements and bank statements) to any Partners for the purposes of securing your business funding. Furthermore, I hereby give Segway and its agents permission to send me correspondence via text message on my mobile cell phone number as listed on this application.
Comments
This field is for validation purposes and should be left unchanged.

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