PRINCIPAL'S NAME: 

Title: 

Company name: 

Street Address: 

City / Town: 

State / Province: 

Zip / Postal Code: 

Telephone Number:            Cell Phone: 

Fax:      Email: 

Start-up        Existing Business          Years in Business: 

Sole Proprietorship       Partnership     Corporation 

Industry: 

Amount of Financing Requested: 

Purpose of Financing: 

                   Franchise Purpose        Equipment Financing       Start-up Financing 

                   Working Capital              Receivables Financing     Factoring  

                   Other: 

Briefly Describe the purpose of Financing:

Personal Guarantees Available:     Yes         No 

Credit History of Owner:   Excellent          Satisfactory          Poor 

Credit History of Company:    Excellent       Satisfactory        Poor 

If a Business Purchase:    Purchase Price  $

Cash Invested by Buyer  $

Total Business Assets  $

Total Liabilities  $

Total Business Net Worth  $

Company's Annual Revenue  $

Company's Annual Profit  $

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