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Unsecured Business
Lines of Credit
Merchant Card Receivables
Purchase Order Financing / Contract Funding
Private Equity
Asset Monetization
Hard Money
Commercial Mortgages
Associate Link

merchant information
Legal Name
 DBA
Organizational Status
Corporation Limited Laibility Company Sole Prop. General Partnership
Organizational ID
Physical address
City              
 State    Zip Code
mailing address
City              

 State    Zip Code
Business Phone
 Business FAX
Contact Name
 Email
 Website
Business Started Date
 Length of ownership
 Federal Tax ID
Business Type
 Sic Code


owner/principal Information

Owners/Principals : Please provide a minimum of 51% ownership and all principals associated with the business. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each business entity that opens an account.

When you open an account, we will ask for Federal Tax Identification Number, physical street address of your business, full legal name of your business and other information, including information regarding associate principals that will allow us to identify your company.
Name
 Marital Status
 Title
 Ownership%
 Date of Birth
Home Address
 Own Rent

City

State

Zip

 How long
Home Phone
 Cell Phone
 SSN
 State/Driver License#
 Prior Bankruptcy
Yes No
Name(2)
 Marital Status(2)
 Title(2)
 Ownership%(2)
 Date of Birth(2)
Home Address(2)
 Own Rent

City(2)

State(2)

Zip(2)

 How long(2)

Home Phone(2)
 Cell Phone(2)
 SSN(2)
 State/Driver License#(2)
 Prior Bankruptcy(2)
Yes No


BUSINESS PROPERTY INFORMATION
Own Rent How long
Square Footage
 Monthly Rent/Mortgage
Is the Business payment current
Yes No		 If No, how many months behind
Landlord/Mortgage Company
 Contact
Phone
 Fax


business references
Company
Contact
 Phone
Company
Contact
 Phone
Company
Contact
 Phone

Nearest relative, not currently living with you:
Company
Contact
 Phone


miscellauneous information
Amount Requested
 Intended use of funds

Are you associated with any other business?
Yes No

 If yes, which one(s)?
Is the Business currently paying a Business Cash Advance
Yes No		 Name of Cash Advance Provider
Current Cash Advance Balance
 Are there any UCC Filings against the Business Assets
Yes No
Are you current with your Personal, State, & Federal Taxes
Yes No

Are there any Liens against the Business or Owner(s):
Yes No

Are there any judgements against the Business or Owner(s):
Yes No

  
Signature
 Title
Print Name
 Date
Signature
 Title

Print Name
 Date
  
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