LEY Capital Business Loan Application

Small Business Application

Complete the business application based on the extracted PDF fields. Fields marked required are mandatory; all others are optional unless legally necessary.
Primary Bank/Internal Use
Bank
Dept/Branch or Cost Center
Officer Name/Number
Business Information
Borrower Name

First NameMiddle NameLast Name
Social Security
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DBA
Years in Business
Business Type

Other
State Incorporated
Description of Business or Service
Business Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Is the Borrower an Asset Holding Company?
Business Name
EIN Number
Is Operating Company Co-Borrower or Guarantor?
Business Mailing Address (if applicable)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Loan Request Details
Loan Purpose
Product Type

Other
Payment Type
Rate Option
Requested Amount
Length of Term (months)
Requested Amortization (months)
Estimated Payment Amount
Collateral Description
Collateral Value
1st Lien Balance
Joint Credit Initials
Business Financials
Number of Employees
Gross Annual Revenue/Sales
Borrower's Net Income
Total Annual Business Depreciation
Total Interest Paid
Total Cash Assets in the Bank
Total Liabilities
Net Worth
Total Monthly Payments
Business Premises/Lease
Premises Status
Name of Lessor
Monthly Lease Payment
Years Remaining on Lease
Business Debts
Name of Creditor
Balance Owing
Monthly Payment
Pay with loan proceeds
Collateral
Payment Terms
Business Deposit Accounts
Business Deposit Accounts
Account Type
Number of Accounts
Aggregate Balances
Owner 1
Owner 1 Name

First NameLast Name
Government ID Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Title
Ownership Percentage
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Home or Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Years Owned
Years in Line of Business
Gross Monthly Income
Total Monthly Payments
Housing Status
Employer
Years Employed
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Deposit Accounts
Ownership Percentage
Ownership Type
Email Address
example@example.com
Citizenship Status
Marital Status
Sources of Funds

Other
Additional Information
Related Business/Credit Issues
Has the business ever filed bankruptcy?
Bankruptcy type
When was the bankruptcy filed?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Is the business currently or previously involved in a lawsuit?
Explain the lawsuit
Are there any tax liens against the business?
Who is authorized to sign?

First NameMiddle NameLast Name
Signatures/Authorization
Applicant 1 Signature
Applicant 1 Print Name

First NameMiddle NameLast Name
Applicant 1 Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Guarantor 1 Signature
Guarantor 1 Print Name

First NameMiddle NameLast Name
Guarantor 1 Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
File Upload ID, SS, Bank Statements

Cancelof
Refer by Account Executive

Other
Should be Empty:

Small Business Application

Primary Bank/Internal Use

Business Information

Loan Request Details

Business Financials

Business Premises/Lease

Business Debts

Business Deposit Accounts

Owner 1

Related Business/Credit Issues

Signatures/Authorization