Pre-Qualification Authorization
Business Information
Business Legal Name:
*
Business DBA Name:
*
Business Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Phone:
*
Website:
Business Email:
*
example@example.com
Tax ID:
*
Business Inception Date:
*
-
Month
-
Day
Year
Date
Business Entity:
*
Corp
LLC
LLP
Partnership
Sole Prop
Business Description:
*
Annual Revenue:
Owner(s) Principal(s) Information
Name (Primary Owner):
*
Title:
*
% of Ownership:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Home Status:
*
Own:
Rent:
Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email:
*
example@example.com
Phone:
*
SSN:
*
Annual Income:
Drivers License #
*
State of Issue:
*
Addtional Owner/Partner Information
Name:
*
% of Ownership:
*
Title:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Home Status:
*
Own:
Rent:
Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email:
*
example@example.com
Phone:
*
SSN:
*
Annual Income:
Drivers License #
*
State of Issue:
*
Signatures
Please date and sign below
The above information, together with any accompanying financial statements, schedules, or other materials, is submitted for the purpose of obtaining credit and is warranted to be true, correct and complete. The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his/her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and shall hold PCS Loan and its assignees, agents or nominees harmless from same. You understand that such investigation may include seeking information as to the background, credit and financial responsibility of your officers and principals (or any of them). The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, r color, religion, national origin, sex, marital status or age (provided the applicant has the the capacity to to enter into the binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please write to 317 W Bedford Ave., Suite #105 Fresno, CA 93711 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial of credit within 30 days of receiving your request for the statement.
Type Name (Primary Owner):
*
Primary Owner Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Type Name (Additional Owner/Partner):
*
2nd Owner Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: