Navia Robotics Service Robot Financing Application

"*" indicates required fields

Business Information

Total Cost of Robot Invoice

Legal Business Name*

Please attach a copy of your current business license

Business Phone Number*

Name of Restaurant*

Business Description*

Name of Primary Bank*

Please attach a voided check with the document uploads

Restaurant Location*

Street Address City State ZIP Code

Years in Business*

Annual Revenue*

Business Structure*

Company Website*

Federal Tax ID #*

Preferred Lease Terms

Service Robot Details

Please Provide Details on your Service Robot order *Attach invoices below*

Required Attachments*

Drop files here or

Max. file size: 32 MB.

Please upload the following 1) 3-months bank statements, 2) Copy of Drivers License Front/Back 3) Invoices for all equipment 4) Copy of current business license 6) voided company check

Signatures

Signature*

Name/Title*

Date*

Owner Information

Name*

First Last

SSN #*

% Ownership*

Number of Owners*

Cell Phone #*

Email Address*

Date of Birth*

Home Address*

Street Address City State ZIP Code

Owner #2

Add Owner #2 Information

Owner 2 Information

Name*

First Last

Social Security Number*

% Ownership*

Number of Owners

Cell Phone #*

Email Address*

Date of Birth

Address*

Street Address City State ZIP Code

Patriot Act Compliance Information

Applicants Drivers License Number*

Issuing State

Expiration Date*

Signature of Applicant*

Date*

Signature of Co-Applicant

Date

Phone

This field is for validation purposes and should be left unchanged.