Application Fill out this application to get the process started. General InformationLegal Business Name *DBA if applicableBusiness Structure *-- Select OneLLCS-CorpSole ProprietorCorporationOtherEINBusiness Address *Suite, etcCityStateZIPBusiness Phone *Date Established *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926Industry / NAICS CodeState of Incorporation *Business ContactPrimary Contact Name *Title/Role *Email Address *PhoneLoan RequestAmount Requested *Use of Funds *Working CapitalRefinanceAcquisitionPartner BuyoutDebt ConsolidationExplain use in more detailDesired Term (in months) *-- Select One612182430How soon are funds needed? *-- Select One1-2 weeks3-4 weeksmore than 1 monthCollateral *receivables/inventoryequipmentcommercial real estateresidential real estateotherCollateral DescriptionOwnership InformationOwner(s) and Percentage(s) *Business FinancialsYTD Revenue: *Prior Year Revenue: *YTD Net Income: *Prior Year Net Income: *Accounting: *AccrualCash BasisExisting DebtCurrent Debt Amount *Monthly Debt Service *Any MCA or high-interest loans? *YesNoLoan Amount *Any lawsuits, liens or judgements active or pending? *YesNoPlease describe in general.Has the business ever been through a bankruptcy?YesNoWhen was this?Are you currently in talks to sell any part of the business?YesNoSubmit ApplicationPlease do not fill in this field.
