LOAN APPLICATION

LOAN APPLICATION
BUSINESS INFORMATION
Legal/corporate name:
DBA:
Physical address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Fax:
Federal tax ID:
Contact:
E-mail:
example@example.com
Website:
Date Business started:

MonthDayYear
Date
Length of ownership:
Years at location:
# of location:

OWNERSHIP
Name:

First NameLast Name
Home Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth:

MonthDayYear
Date
SSN
Driver's license #
State issued:
% Ownership of company:
Title:
If more than one owner please attach additional sheet:

Cancelof

LEASE
Landlord Name:
Contact:
Work Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Fax:
Monthly rent:
Square feet:
Date of lease start:

MonthDayYear
Date
Date of lease end:

MonthDayYear
Date

TRADE SUPPLIES
Name

First NameLast Name
Contact
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Contact
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

CASH ADVANCE
Amount requested:
Have you used cash advance plan before?:
Average Visa/MasterCard monthly sales:
Company:
Average gross monthly sales:
Original balance:
Current balance:
Average ticket size:
Use of proceeds:
Holdback %:

OTHER INFORMATION
Current processing company:
SIGNATURE
By sign,ng the Verchant and its owners"principals: (1) certify that all information on and documents submitted in mnnection with this Application are true, correct, and oamplete, and (2) authorize M&P, its agents,

partners. and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties. in order to verify any information provided on the Application.
Signature
Date

MonthDayYear
Date
Should be Empty: