Client Intake Form
Heritage Commercial Funding
Funding Needs
Grow an existing business
Improve cash flow
Start a new business
Buy an existing business
Invest in real estate
Other
Target Funding Amount $
Do you have existing Term Sheets in possession?
Yes
No
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Company Information
Legal Company Name
State of Incorporation
Federal Tax ID
Physical Address (no PO Boxes)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Business Inception Date
-
Month
-
Day
Year
Date
Does your business have a separate business bank account?
Yes
No
Legal Entity
Corporation
General Partnership
LLC
LLP
Other
Company Type/Industry
Rent or Own?
Rent
Own
Landlord Name
First Name
Last Name
Landlord Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Financial Information
Annual Business Revenue
Average Bank Balance
Accounts Receivable Balance
Inventory Value
Equipment Value
Commercial Property Value
Personal Property Value
Monthly Credit Card Volume
Has your business accepted credit cards for at least 3 months?
Yes
No
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Owner Information
If you are applying for individual credit in your name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment, complete Owner Information 1 and omit Owner Information 2. If this is an application for joint credit with another person, complete both Owner Information 1 and 2.
Owner 1 Information
Legal Name
First Name
Last 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.
Email
example@example.com
Social Security Number
Date of Birth
-
Month
-
Day
Year
Date
Annual income
Home Address (no PO Boxes):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Ownership %
FICO Score (Approximate)
Current or Past Bankruptcy (Year Discharged or N/A)
Current Tax Lien?
Yes
No
Current US Citizen?
Yes
No
Owner 2 Information
Legal Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Social Security Number
Date of Birth
-
Month
-
Day
Year
Date
Annual Income
Home Address (no PO Boxes)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Ownership %
FICO Score (Approximate)
Past or Current Bankruptcy (Year Discharged or N/A)
Current Tax Lien?
Yes
No
Current US Citizen?
Yes
No
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Documents Requested
Please upload the following documents: (1) Business Debt Schedule; (2) Four months of business bank statements; (3) Last two years of financial statements - Balance Sheet and P&L; (4) Last two years of business tax returns; (5) Current A/R, A/P aging reports
Example of Business Debt Schedule (Doc 1) shown below:
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Consent
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
YES
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