AmericanSBA Final Document


Owner First and Last Name:

Business Legal Name:

Business DBA:

Legal Incorporation Type:

State of Incorporation:

Federal Tax ID:

Business Location:

Physical Address:


Industry Type:


Monthly Revenue:

Average Transaction Amount:

Average Credit Card Sales:

Any Open MCA or Loans?

MCA/Loan Balances:

Business Owner Information: 

Business Owner Phone Number:

Business Start Date Under Current MGMT:

Business Owner Email:

Social Security Number:

Date of Birth:

Home Address:

Second Owner Name:

2nd Owner SSN:

2nd Owner DOB:

By signing below, each of the above listed business and business owner (individually and collectively, “you”)
authorize American Small Business Advisory, Inc (“AmericanSBA”) and each of its representatives, partners, successors, affiliates,
contractors, designees, and assigns (referred to individually as a “Recipient” and collectively as the
“Recipients”) to obtain consumer or personal, business and investigative reports and other information about
you, Including credit card processor statements and bank statements, from one or more consumer reporting
agencies, such as TransUnion, Experian, and Equifax, and from other credit bureaus, banks, creditors and other
third parties (1) to review the transaction you have applied for, including to authenticate your identity, verify
information in your application, make underwriting decisions, and for related purposes, (2) if your application
results in your entering into any transaction with any of the Recipients, to service, monitor, collect and enforce
the transaction, and (3) from time to time, to determine your eligibility for other financial products that may be
offered by the Companies. You also authorize (i) AmericanSBA, as agent for the Recipients, to transmit this application
form, along with any of the foregoing information obtained in connection with this application, to any or all of the
Recipients for the foregoing purposes as well as (ii) to transmit this application Form, Along with any of the foregoing information obtained in connection with this application for the foregoing purposes. You also consent
to the release, by any creditor or financial institution, of any information relating to any of you, to AmericanSBA, as
agent on behalf of the Recipients and to each of the Recipients, on its own behalf. You are also accepting and agreeing to our privacy policy that you can find in our footer section of our home page.

Consent to Electronic Disclosures:
You expressly consent to transactions and disclosures with Recipients online and electronically. Disclosure will
be provided to you either on the screen, on Recipients’ website or via electronic mail to the email address you
Withdrawing Consent: You may withdraw consent of telephone calls or electronic disclosures by calling
AmericanSBA Customer Service (754) 227-5799 or emailing

Leave this empty:

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Signature Certificate
Document name: AmericanSBA Final Document
lock iconUnique Document ID: 7286a5d01f4250b4bf3a8c6adab4259aa7d2bc1c
Timestamp Audit
April 2, 2020 1:40 pm CSTAmericanSBA Final Document Uploaded by Ernesto Zamora - IP