PRINCIPAL'S NAME:

Title:

Company Name:

Street Address:

City:    State:    Zip:

Telephone:    Cellular Phone:

Fax:    E-mail:

Start-up    Existing Business   Years in Business

Sole Proprietorship    Partnership    Corporation

Industry:

Amount of Financing Requested:

Purpose of Financing: Franchise Purchase    Equipment Financing    Start-up Financing    Working Capital     Receivables Financing      Factoring    Other:

Briefly Describe 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 Business Liabilities $

Total Business Net Worth $

Company's Annual Revenue $

Company's Annual Net Profit $

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