Personal Information Let's get to know you better! Provide your personal information to kickstart the journey towards your business loan. We'll make it quick and easy! Legal First Name* Legal Last Name* Email Address* Phone Number* Business Owner’s Date of Birth* Business Owner’s Social Security Number* Business Owner’s Driver's License Number* State Issued* Expiration Date* Back | Next Business Information Your business is our priority! Share the details about your company to unlock the best lending solutions tailored to your needs. Let's propel your business to new heights! Business Name* DBA Name Business Address* Federal/State Tax ID Year Established Company Website/Owner's Email Address State of Incorporation DUNS Number Entity Type Name of Business Owner (If different from applicant) Business Owner’s Title Business Owner’s Home Address Percentage Ownership Back | Next Financing Details Great things are ahead! Provide the financing details for your business loan, and we'll work our magic to connect you with the perfect funding option. Your success is our mission! Type of Financing Requested Length of Financing Purpose of Financing Business Loan Type Amount Requested Gross Annual Sales Average Monthly Sales Lease or Mortgage YesNo Lease/Mortgage Payment Landlord/Lender Name Landlord/Lender Contact (Phone or Email) Back | Next Accounts Receivable Financing Application Step 1: Company Profile Please provide the following information about your company: FED I.D. Number * State Tax Number * DUNS Number * Total Number of Employees * Year Established * Year Filed * Business Type * Open an Operating Account * YesNo SIC Code * Previous Next Accounts Receivable Financing Application Step 2: Bank References Please provide the following bank references: Institution * Contact * Address * City * State * —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Telephone * Fax Account Number * Previous Next Accounts Receivable Financing Application Step 3: Supplier References Please provide the following supplier references: Contact * Telephone * Fax City * State * —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Previous Next Accounts Receivable Financing Application Step 4: Sales Information Please provide the following sales information: Projected Sales Volume Next 12 Months ($) * Avg. Monthly Sales Vol. ($) * Avg. Number of Inv. * Return Policy * Warranty Period * Sales Volume Previous 12 Months ($) * Avg. Number of Inv. * Are any sales made on consignment or guaranteed sales? * YesNo Billing Frequency * —Please choose an option—DailyWeeklyMonthly A/R Turnover * Briefly describe the nature of your product or service * Previous Next Accounts Receivable Financing Application Step 5: Secured Party Information Please provide the following secured party information: Have you given a security interest in, or made an Assignment of, your accounts receivable? * YesNo If yes, to whom? (Name) * Address * City * State * —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Telephone Fax Previous Next Accounts Receivable Financing Application Step 6: Company History Please answer the following questions: Been convicted of a felony? * YesNo Filed bankruptcy or had a petition on bankruptcy filed against it? * YesNo Made an assignment for the benefit of creditors? * YesNo Had a receiver appointed? * YesNo Had or have a Federal, State, County or Municipal lien/levy filed against it? * YesNo Been involved or are currently engaged in, or threatened with any litigation? * YesNo Previous Next Accounts Receivable Financing Application Step 7: Additional Information Please provide the following additional information: Are you currently past due on any federal or state taxes? * YesNo Do you currently have a payment plan for delinquent taxes? * YesNo Do you purchase products or services from your customers? * YesNo Are there any unsatisfied judgments against your business? * YesNo Are all licenses and permits required to operate your business current? * YesNo Do you anticipate a major change in ownership or management in the next 12 months? * YesNo Are regular financial statements prepared? * YesNo Previous Next Accounts Receivable Financing Application Step 8: Required Documents To expedite the approval process, please complete/attach the following documents: Financial Statement - Business (previous 2 fiscal years as well as most recent interim statement-YTD, Balance Sheet, P&L) Certificate of Insurance Accounts Receivable Detail and Summary Aging - Most Recent A Copy of a Complete Invoice with Supporting Documents Copy of Organizational Documents e.g., Articles of Incorporation, Articles of Organization, By Laws, Operating Agreement, etc. Copy of DBA filing (if applicable) Personal Financial Statement (all owners) Accounts Payable Summary Aging Customer List with Address, Zip Code, and Phone Numbers (Excel format) Bank Statements (most recent 3 months) Most Recent Tax Return Copy of each Principal's Driver's License Previous