HARRIS MONEY

BUSINESS LINE of CREDIT PRE-QUALIFICATION FORM
BUSINESS INFORMATION
Legal Business Name*
Business DBA Name - if any
Type of Business Entity (LLC, C or S Corp, Partnership, Sole Proprietor)*
Industry *
State of Incorporation (xx) *
Business Street Address, City, State, Zip*
Business Location Phone #*
Fax #
Website
Gross Annual Sales*
Business Start*
Fed Tax ID*
Own or Rent Business Location*
Monthly Payment - Rent or Mortgage*
Requested Amount of Funds & Use of Funds
OWNER INFORMATION
Owner Legal First and Last Name*
SSN
Date of Birth (MM/DD/YYYY)
Home Street Address, City, State, Zip*
Home Phone
Mobile Phone*
Email Address*
Own or Rent Home*
Percentage of Ownership
FICO
Applicant Signature
Harris Money, LLC. 108 Beacon St., Bridgeport, CT. 06605

203.951.3440 www.harrismoney.com info@harrismoney.com
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