B
USINESS
F
INANCING
A
PPLICATION
Referring Broker/Affiliate (if applicable) Business Name Contact Person:________________________ Email:_____________________________________________ Phone:_________________________ Fax:_______________________________
TELL US ABOUT YOUR REQUEST
Ref Code: Web.15 .Amount Requested $__________________ Minimum Amount Needed $__________________
Describe the Type of Loan Reason for your Loan Request (Be specific)
Use of Funds (1) $
(2) $
(3) $
(4) $
GENERAL BUSINESS INFORMATION
Legal Business Name__________________________________________ DBA_________________________________________ State Tax ID Number __________________________ Federal Tax ID Number
Tel Fax Alternate Contact #
Street___________________________________________ City____________________________State_____ Zip Any Open or Old Tax Lien(s)? Amount(s)?____________________________________________(provide proof of payment if paid) Total Assets $__________________ Total Liabilities $__________________ Net Worth $
Nature of Business / Company Type _____________________________________ Website _______________________________ Business Inception Date MM/DD/YYYY ____/____/_______ No. of Employees_____ Dunn & Bradstreet #
Revenues Gross: 2013 $_____________ 2014 $_____________ Year to Date-2015 $_____________(thru_________/month) Net: 2013 $_____________ 2014 $_____________ Year to Date-2015 $_____________(thru_________/month) *Provide taxes and financials if available via fax.
Sole Proprietorship___, Partnership___, C-Corp___, Sub-S Corp___, LLC Corp___, Other
APPLICANT INFORMATION
First Name_____________________________Last Name_______________________________ Company Title________________ Home & Cell Phone__________________ __________________ Email Address
Home Address_____________________________________ City______________________________State____ Zip___________ Social Security Number_______-_______-_______ Date of Birth ______-______-_______ % Ownership
Total Household Income (yearly) $______________ Total Assets $_______________ Total Liabilities $ Married___________ Single ____________ Separated ___________ Divorced ______________
CO-APPLICANT INFORMATION
First Name_____________________________Last Name_______________________________ Company Title________________ Home & Cell Phone__________________ __________________ Email Address
Home Address_____________________________________ City______________________________State____ Zip___________ Social Security Number_______-_______-_______ Date of Birth ______-______-_______ % Ownership
BANKING AND ACCOUNT INFORMATION
#1 Bank/Institution _______________________________________________ Account # Type of Account: ___Checking ___Savings ___Other Average Monthly Deposits$
Contact Name____________________________________ Phone #: Fax #:
Date Opened: NSF’s Current Balance: Signer:
#2 Bank/Institution _______________________________________________ Account # Type of Account: ___Checking ___Savings ___Other Average Monthly Deposits$
Contact Name____________________________________ Phone #: Fax #:
Date Opened: NSF’s Current Balance: Signer:
ASSET & ADDITIONAL INFORMATION
(PLEASE FILL OUT COMPLTETLY) Real Estate OwnedValue of Residential Real Estate Owned $__________________ Mortgage Balance(s) $ ___________________ Description of Residential Real Estate & Address:
1) Value of Commercial Real Estate Owned $_______________ Mortgage Balance $ ____________
Description of Commercial Real Estate & Address:
2) Value of Commercial Real Estate Owned $_______________ Mortgage Balance $ ____________
Description of Commercial Real Estate & Address:
Mortgage/Land Lord Information (If you don't own your commercial property/business location please fill out Landlord info).
1) Mortgage/Landlord Holder Name Phone # Fax #
How many years remain on Lease? How many years remain on Note?________ Mortgage Balance
2) Mortgage/Landlord Holder Name Phone # Fax #
How many years remain on Lease? How many years remain on Note?________ Mortgage Balance
Business Equipment Owned (Free and Clear)
Office Equipment & Furnishings $ _________________ (Computers, Telephones, POS Systems, Copiers, Furniture, etc) Industrial and Manufacturing Equipment $ _________________
Construction and Farm Equipment $ ________________ (Yellow Iron-Tractors, Loaders, Dozers, Generators,..Etc) Medical and Dental Equipment $ _____________ Other $ _____________ Describe
Equipment Purchases
Do you plan to purchase equipment? Yes or No If yes, type:
Vendor Name:___________________________Vendor Phone #:________________________Contact: ___________________
Receivables & Purchase Orders
Total receivables $ Avg. Inv. Size $ # of Accts. Mo. Sales Vol. Total Receivables Current $ 30-60 DAYS 60-90 DAYS Over 90 Purchase Orders $_____________________________________________ Avg. PO Size $ _____________ # of Accts Have you received PO financing previously or now? Yes or No if yes, who:_______________________________________
Merchant Account
Average Monthly Credit Card Volume (Visa/MasterCard): $ ____________ How Many Merchant/Credit Card Accounts? ________ Merchant/Credit Card Processing Info: Processor: _____________Contact #:____________________Terminal Type:___________ How Processed: % Card Swiped:_______ % Manually Keyed:_______ % Phone/Mail Order:________ % Internet:________
TRADE REFERENCE(S)
(The longer the trade reference has been open the better and will be verified).______________________
1
. Company Name Account # Phone Number Fax Number____________ ________________________ _____________ _______________ ________________ _________________ Open Date Signer(s) Satisfactory? High Credit Current Balance Contact Name
______________________
2
. Company Name Account # Phone Number Fax Number____________ ________________________ _____________ _______________ ________________ _________________ Open Date Signer(s) Satisfactory? High Credit Current Balance Contact Name
______________________
3
. Company Name Account # Phone Number Fax Number____________ ________________________ _____________ _______________ ________________ _________________ Open Date Signer(s) Satisfactory? High Credit Current Balance Contact Name
CREDIT EVALUATION
•Do you know your personal credit score? Yes or No If so, what are Score(s)? _______________________________________
•Do you know if you have a D & B Business Credit File? Yes or No Do you know your D & B Paydex Score? __________________
•Do you have any UCC Lien Filings? Yes or No Amount(s)?____________________ What is the UCC Filing on?_______________
•Do you have any existing Credit Lines? Yes or No Balance(s)? __________________ With Who?___________________________
MISCELLANEOUS INFORMATION
Do you have any federal & state taxes past due? Yes or No If yes, how much: Federal $ State $
Are you currently under the protection of the United States Bankruptcy Laws? Yes or No
Have you been turned down previously:(This information is critical in determining what issues that need to be overcome). By whom and Reason(s):
Are you currently working with any lender, consultant or broker on this transaction? Yes or No
If yes, who:
AGREEMENT
I/We completed an application containing various information and certify that all of the information is true and complete. I/We further hold FUNDINGEDGE and/or Power2Fund and/or its assigns harmless of any misrepresentation on the Business Financing Application and/or other documents provided. I/We hereby authorize FUNDINGEDGE and/or Power2Fund and/or its assigns to investigate my credit worthiness and verify any information provided on my/our application and other related documents.
Business Name
Signature Printed Name Title Date
Signature Printed Name Title Date
A
UTHORIZATION TO
O
BTAIN
C
REDIT
I
NFORMATION
I / We represent and warrant that the information provided in this credit
application is complete, accurate and true. Each individual signing below also
requests and authorizes any lenders or funding source which may be utilized
(collectively referred to as “Lenders”) to obtain information from the references
listed above and obtain commercial and/or consumer credit histories that will be
ongoing and relate not only to the evaluation of the business credit requested, but
also for purposes of reviewing the account, increasing the credit line on the account
(if applicable), taking collection action on the account, and for any other legitimate
purpose associated with the account as may be needed.
A facsimile, electronic or other copy of this signed authorization shall be as valid as
the original.
X
Applicant’s Signature
X
Applicant’s Printed Name Date
Applicant’s Signature
X
Applicant’s Printed Name Date
Applicant’s Signature Applicant’s Printed Name Date
C
ERTIFICATION
&
A
UTHORIZATION
C
ERTIFICATIONThe undersigned hereby certify the following:
1. I am / We are seeking to secure Financing. In applying for this Financing, I/We completed an application containing various information and certify that all of the information is TRUE, COMPLETE, and ACCURATE. I/We further hold FUNDINGEDGE AND/OR POWER2FUND harmless of any misrepresentation on the Financing
Application and/or other documents.
2. I/We understand and agree that FUNDINGEDGE AND/OR POWER2FUND reserves the right to verify information provided on the application.
3. I/We understand that FUNDINGEDGE AND/OR POWER2FUND is acting as my/our correspondent and further acknowledge that all disclosures required by law in regard to the Financing are to be provided by the lender and/or financing entity NOT FUNDINGEDGE AND/OR POWER2FUND.
A
UTHORIZATIONTo Whom It May Concern:
1. I am / We are applying for Financing. As part of the application process, FUNDINGEDGE AND/OR POWER2FUND and/or its assigns are authorized to act on my/our behalf in obtaining the Financing.
2. FUNDINGEDGE AND/OR POWER2FUND and/or its assigns may verify information contained in my/our application and in other documents that have been provided in connection with the Financing. I/We authorize you to provide to FUNDINGEDGE AND/OR POWER2FUND, and/or its assigns, information and documentation that they request. Such information includes, but is not limited to, employment history and income; bank, money market and similar accounts. FUNDINGEDGE AND/OR POWER2FUND and/or its assigns are authorized to pull personal and business credit history on my/our behalf to include but not limited to Experian, TransUnion, Equifax and Dunn & Bradstreet.
3. I/We understand and authorize FUNDINGEDGE AND/OR POWER2FUND to share personal, financial and property information with lenders, investors and/or assigns in the placement of my/our financing request. 4. A copy and/or faxed copy of this Authorization may be accepted as an original.
COMPANYNAME (If Applicable)
BORROWER
______________________________________________________________________________________________
Borrower’s Name - PRINTED Signature Date
SS#________________________ DOB______________Address_________________________________
CO - BORROWER
_____________________________________________________________________________________ Borrower’s Name - PRINTED Signature Date
SS#________________________ DOB______________Address_________________________________
Must be submitted with two (2) forms of Identification. One (1) of the forms of Identification must be a
valid Driver's License or Passport. If possible enlarge the copies of the Identification..