Finance Quick Application

FINANCE QUICK APPLICATION

Application Date:    Application Reference:

Applicant Information

Entity Type: Individual Sole Proprietor Corporation LLC Partnership

Phone:    Email:

Business Information (if applicable)

Industry:    Years in Business:

Requested Financing

Requested Term (months):    Proposed Interest Rate:

Funding Type: Term Loan Line of Credit Equipment Lease

Financial Summary

Average Monthly Revenue:    Average Monthly Expenses:

Credit & Declarations

Has the applicant or any principal been party to bankruptcy, insolvency, or receivership proceedings in the last seven years?     Yes No

Has the applicant or any principal had a judgment, tax lien, or been delinquent on a material obligation in the last seven years?     Yes No

Credit References & Supporting Documents

Supporting Documents Provided (check all that apply): Personal Financial Statement Business Financial Statements Bank Statements Tax Returns Collateral Documentation

Authorizations, Certifications & Notices

By signing below, Applicant certifies that all information provided in this application and accompanying documents is true, accurate and complete. Applicant authorizes the finance provider, its affiliates and agents to obtain and verify consumer and business credit reports, bank account and trade information, and to contact references and third parties to verify any information provided. Applicant understands that this application is not an approval or commitment to lend, and that any financing offered will be subject to the finance provider's underwriting, documentation and collateral requirements.

Applicant further acknowledges that false statements or omissions material to credit decisions may constitute fraud and may result in denial of credit, civil liability or criminal prosecution under applicable law.

Consent to Release: Applicant grants permission to the finance provider to share application data with servicers, insurers, and third-party processors for underwriting and servicing purposes, and agrees that copies of this authorization may be accepted as originals.

Governing Law: This application and any subsequent financing agreements arising from it shall be governed by and construed in accordance with the law of the jurisdiction specified in any resulting agreement. Submission of this application authorizes the finance provider to retain application records.

I authorize the finance provider to obtain consumer and business credit reports and to verify all information provided in this application.

Certification

Certification: I certify under penalty of law that the statements set forth in this application and in any attachments are true and complete to the best of my knowledge and belief. I understand that this application is subject to verification and that additional documentation may be required before a credit decision is made.

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