Line of credit loc app

Business Legal Name*

Business DBA (if applicable)

Mobile Phone*

Business Phone*

Website

Email*

example@example.com

Legal Entity*

Home Based Business?

YesNo

Open Judgements?

YesNo

Open Bankruptcies?*

YesNo

Business Start Date*

Date

Federal Tax ID *

State of Inc/LLC*

Business Address*

Street Address

Street Address Line 2

CityState

Zip

Business Description

Industry Type

Business Rent/Mortgage

Rented/LeasedMortgaged

Mthly Rent/Lease/Mtg Payment

Remaining Term for Rent/Lease

Payment Current?

YesNo

Landord/Mortgage Company Name

Landlord/Mortgage Company Phone Number

Amount Requested*

When Are Funds Needed?

ASAP30 Days60+ Days

Desired Use of Funding Proceeds

Your Annual Business Revenue

Your Average Bank Balance*

Monthly Credit Card Volume

Current Cash Advance?*

YesNo

If So, How Many?

Cash Advance/Loan Balance

Ex: "Loan Provider 1: $50,000, Loan Provider 2: $20,000, Loan Provider 3: $11,500" etc...

First Name*

Last Name*

Title

% Ownership*

Credit Score

Home Address*

Street Address

Street Address Line 2

CityState

Zip

Home Phone*

Date of Birth*

Date

SS#*

Title

AUTHORIZATION & CONSENT

Each of the undersigned, who is either a Principal, Sole Proprietor, or Personal Guarantor of the above-named business, recognizes that his or her individual credit history may be a factor in the evaluation of this application for funding. Each of the undersigned hereby authorizes Firestone Holdings Ltd. dba Line of Credit LOC, its assigns, representatives, affiliate partners, to obtain consumer and business credit reports (and any updates), and to gather information from third parties, including for fraud prevention, in connection with the review of this application and any future review of the business’s account.

Each of the undersigned further authorizes Line of Credit LOC and any funding provider or lender receiving this application to contact them via telephone (including automated calls), text message, email, or direct mail for application updates, marketing, and promotional offers. This includes contact at any phone number or email provided on the application, even if such numbers are listed on a state, federal, or corporate do-not-call registry.

Each of the undersigned also consents to receive legally required notices and disclosures via electronic mail to the email address listed on the application.

Owner Signature*

Please attach Last 4 Months of Business Bank Statements

Additional supporting documents can be uploaded here as well.

Date Of Submission*

Date

Funding Application

Business Information

Funding Information

OWNER INFORMATION