Financial Services Application
Company Information
Company Overview
*
Primary Contact
*
Locations
*
Owners
*
Subsidiaries and Related Entities
*
Employees
How Many Full Time Employees do you Currently Have?
How Many Full Time Employees do you Expect to Have in the Next 12 Months?
How Many Part Time Employees do you Currently Have?
How Many Part Time Employees do you Expect to Have in the Next 12 Months?
Financial Information
Funding Amount Requested
Use of Funds (Check all that apply)
AR Financing
Inventory Financing
Purchase Order Financing
Acquisition of New Location or Business
Growth Capital
PE Buyout
Dividend Recap
Other
*
*
Collateral
Accounts Receivable less than 90 days Aging Inventory (Cost Basis)
Inventory (Cost Basis)
Machinery & Equipment (Current Fair Market Value)
Real Estate (Net Equity Available)
Existing Debt
Does Your Business Currently Have Existing Debt
Yes
No
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