Business Loan Application

Business Name
Entity Type
DBA's
Separate with commas
State of Incorporation
Formation Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate of Company Formation
EIN
00-0000000
D-U-N-S & Broadstreet #
00-000-0000
Business Website
Business Email Address
example@example.com
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Address (where business is performed)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Registered Address (where business is registered)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Additional Facilities (please list in format below)
#.) Facility Name - Facility Use - Facility Address - Leased/Owned - Date of Occupation - Landlord Name/Company, #.).......
Industry Sector
Automotive Business Type
Stage of Company

Other
Brief Description of Your Business
Chief Executive Officer

PrefixFirst NameMiddle NameLast Name
Email
example@ecompanyname.com
Chairperson

PrefixFirst NameMiddle NameLast Name
Email
example@ecompanyname.com
Corporate Legal Counsel

PrefixFirst NameMiddle NameLast Name
Email
example@ecompanyname.com
Human Resources Contact

PrefixFirst NameMiddle NameLast Name
Email
example@ecompanyname.com
Total # of Shareholders Currently
Total Common Shares Issued
Total Common Shares Owned
Total Preferred Shares Issued
Total Preferred Shares Owned
Current Funding Stage
Total Capital Raised to Date
USD ($)
Total Number of Investors
USD ($)
Total Shares Owed / Awarded to Investors (ITD)
Total Company Liabilities
as of 01 JAN 2026
Total Company Liabilities Paid (ITD)
as of 01 JAN 2026
Total Investor Liabilities Paid (ITD)
as of 01 JAN 2026
Type of Debt
Amount of Funding Sought (USD)
Describe How the Funding Will Be Used
Total Preferred Shares Offered
Total Common Shares Offered
Vesting Period
Years (Round Up)
Board Voting Power Offered?
Dividends Offered?
OWNER / OFFICER #1
Owner/Founder's Full Name

PrefixFirst NameMiddle NameLast NameSuffix
SSN
000-00-0000
Title
Founder?
Corporate Officer?
Corporate Officer Title
Education Level
Personal Net Worth
USD ($) - Total Value of all assets owned by individual
Wages Earned (2025)
USD ($) - All income derived from the company
Total Capital Contributions
USD ($) - All capital invested in the company to date
Shares Owned
Founder's Email Address
example@example.com
Founder's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Professional LinkedIn URL
OWNER / OFFICER #2

If Applicable
Owner/Founder's Full Name

PrefixFirst NameMiddle NameLast NameSuffix
SSN
Title
Founder?
Corporate Officer?
Corporate Officer Title
Education Level
Personal Net Worth
USD ($) - Total Value of all assets owned by individual
Wages Earned (2025)
USD ($) - All income derived from the company
Total Capital Contributions
USD ($) - All capital invested in the company to date
Company Shares Owned
Founder's Email Address
example@example.com
Founder's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Professional LinkedIn URL
OWNER / OFFICER #3

If Applicable
Owner/Founder's Full Name

PrefixFirst NameMiddle NameLast NameSuffix
SSN
Title
Founder?
Corporate Officer?
Corporate Officer Title
Education Level
Personal Net Worth
USD ($) - Total Value of all assets owned by individual
Wages Earned (2025)
USD ($) - All income derived from the company
Total Capital Contributions
USD ($) - All capital invested in the company to date
Company Shares Owned
Founder's Email Address
example@example.com
Founder's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Professional LinkedIn URL
Additional Owners

Please list all additional owners below (Ex: Full Name, Total Shares Owned, Share Type OwnerFirst Investment Date)
Additional Officers

Please list all additional officers below (Ex: Full Name, Title, Start Date)
Monthly Gross Revenue
USD
2025 Total Gross Revenue
USD ($)
2024 Total Gross Revenue
USD ($)
Primary Revenue Source
Select multiple if applicable
Current Company Valuation
USD ($)- as of 01 JAN 2026 (or most recent fiscal quarter)
Current Company Assets Total Value
USD ($)- as of 01 JAN 2026 (or most recent fiscal quarter)
Current Company Real Estate Total Value
USD ($)- as of 01 JAN 2026 (or most recent fiscal quarter)
Current Company Inventory Total Value
USD ($)- as of 01 JAN 2026 (or most recent fiscal quarter)
Professional Reference #1
Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Reference Type
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Professional Reference #2
Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Reference Type
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Financial Reference #1
Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference Type
Please indicate whether the Company is willing and able to provide any of the following in support of this application. Check all that apply and provide supporting details where applicable:
Personal Guarantor Name

PrefixFirst NameMiddle NameLast NameSuffix
Commercial Guarantor Name
Collateral Value Estimate
Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@companyname.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Representative
Authorized Representative
Authorized Representative
Authorized Representative
Upload Pitch Deck (PDF, PPT, or DOC)

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Upload Executive Summary (PDF, PPT, or DOC)

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Upload Company Capitalization Table (PDF, PPT, or DOC)

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Upload Most Recent Business Tax Return - 2024 or 2025 (PDF, PPT, or DOC)

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Upload Investor ROI Projections (PDF, PPT, or DOC)

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Upload 2+ Quarterly Income Statements (PDF, PPT, or DOC)

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Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

OWNER / OFFICER #1

OWNER / OFFICER #2

OWNER / OFFICER #3

Additional Owners

Additional Officers

Professional Reference #1

Professional Reference #2

Financial Reference #1