Principals Name
*
Title or Position
Email
*
Company Name
E-mail Address:
*
Address:
City:
State:
Zip:
Work Phone:
Cellular Phone
Fax Number:
When is the best time to contact you?
Morning
Afternoon
Evening
What is the best means to contact you?
Phone
E-mail
Fax
*
Start-up
Existing Business
Years in Business
Industry
Structure of your Organization
Sole Proprietorship
Partnership
Corporation
Amount of financing requested
Purpose of financing
Franchise purchase
Equipment financing
Start-up financing
Factoring
Receivables Financing
Working Capital
Other (Please Specify)
Personal Guarantees
Yes
No
Credit history of Owner or Principal
Excellent
Satisfactory
Poor
Credit history of Business
Excellent
Satisfactory
Poor
If a business, purchase price
Message:
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