Aspen Financial

BUSINESS INFORMATION
Legal/Corporate Name
DBA
Address

Physical Address

Street Address Line 2

CityState

Zip
Fax #
Federal Tax ID
Date Business Started
Date Business Started

MonthDayYear
Date
Length of Ownership
Website
Type of Entity (circle one): Sole Proprietorship Partnership Corporation LLC Other
Email Address
example@example.com
Type of Business (circle all that apply): RetailRestaurant MO/TOWholesale
Product/Service Sold
MERCHANT/OWNER INFORMATION
Corporate Officer/Owner Name
Title
Ownership %
Address

Home Address

Street Address Line 2

CityState

Zip
SSN
Date of Birth

MonthDayYear
Date
Home #
Cell #
Partner Name
Title
Ownership %
Address

Home Address

Street Address Line 2

CityState

Zip
SSN
Date of Birth

MonthDayYear
Date
Home #
Cell #
BUSINESS PROPERTY INFORMATION
Business Landlord or Business Mortgage Bank
Contact Name and/or Account #
Phone #
BUSINESS TRADE REFERENCES
(Please list at least 3 trade suppliers. Please attach any additional references on a separate page Contact Name and/or Account #:Phone #:
Business Name
Contact Name and/or Account #
Contact Name and/or Account #
Business Name
Contact Name and/or Account #
Phone #
Business Name
Contact Name and/or Account #
Phone #
Business Name
Contact Name and/or Account #
Phone #
AGENT USE ONLY
Processing Company
Number of Terminals
Terminal Type
Requested Advance Amount
Requested Daily Withholding
Monthly Volume
Prior/Current Cash Advance Company (if applicable)
Balance
By signing & faxing or emailing Aspen Financial Group (AFG) your application, you certify that (1) you are authorized to apply on behalf of the company whose full legal name appears above under the Company Information portion of the Application for a business from AFG and (II) all information you provide within the Application and other supporting documents is true and complete and that you will notify AFG of material changes to such information. You understand & agree that AFG and it's agents and assignees are authorized to contact 3rd parties to make inquires in evaluating your Application (including requesting business & personal credit bureau reports from credit reporting agencies and other sources) or for any update, renewal, extension of credit bureau name and address. You understand and agree that AFG may provide credit & other information from the Application and on the signing individual(s) & the company with 3rd parties who may use the information for any lawful purpose, including for the purpose of offering credit and/or other products & services to the signing individual(s) and/or the company.
Applicant's Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

BUSINESS INFORMATION

MERCHANT/OWNER INFORMATION

BUSINESS PROPERTY INFORMATION

BUSINESS TRADE REFERENCES

AGENT USE ONLY