BUSINESS FUNDING APPLICATION

BUSINESS FUNDING APPLICATION

Lidia Hicks - Certified Money Broker - 405-702-2432-info@hlcs.services
BORROWER'S INFORMATION
Primary Contact Name

First NameLast Name
Primary Contact Email
example@example.com
Cell Phone Number
What is your Credit Score Range?
Is there a Co-borrower?
CO-BORROWER'S INFORMATION
Primary Contact Name

First NameLast Name
Primary Contact Email
example@example.com
Cell Phone Number
What is your Credit Score Range?
BUSINESS ENTITY INFORMATION
Business Legal Name
Business trade name or DBA
If applicable
What is the legal structure of your business?
Which state is your business in?
How long have you been in business?
Which industry is your business in?
Business EIN
What percentage (%) of the business do you own?
What is your title at the business?
CEO, Managing Partner, Director, etc.
Number of employees
How much funding are you requesting?
What is the Gross Annual Revenue for the business?
Briefly describe your business
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number

Area CodePhone Number
ELIGIBILITY QUESTIONS
Have You Ever Defaulted on a Government Loan? (i.e. SBA Loan, Student Loan, etc.)
Are the majority owners of the business US citizens or Legal Permanent Residents?
Have you exhausted all funding options?
In a paragraph please explain why you need funding and how much do you need.
How will you using the funds: payroll, rent, inventory, working capital etc.
Should be Empty:

BORROWER'S INFORMATION