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*
720 or higher680-719620-679600-619580-599580 or belowForeign National, No Score
YesNo
CO-BORROWER'S INFORMATION
Primary Contact Name

First NameLast Name
Primary Contact Email
example@example.com
Cell Phone Number
720 or higher680-719620-679600-619580-599580 or belowForeign National, No Score
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
YesNo
YesNo
YesNo
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