BUSINESS LOAN APPLICATION FORM
Complete the loan application using the fields extracted from the attached PDF. All fields are optional unless the PDF clearly marked them as required.
Please complete this form in full and provide all required documents. Incomplete applications may delay the processing of your request.
1. BUSINESS INFORMATION
Legal Business Name
*
DBA / Trade Name (if any)
Business Address
*
City
*
State
*
ZIP Code
*
Business Phone Number
*
Format: (000) 000-0000.
Business Email Address
*
example@example.com
Industry
*
Business Start Date
*
Entity Type (Check one)
*
Sole Proprietorship
Partnership
LLC
Corporation
Other
EIN (Tax ID Number)
*
Estimated Monthly Revenue
*
Requested Funding Amount
*
Purpose of Funds (Check all that apply)
*
Working Capital
Inventory
Payroll
Equipment
Expansion
Marketing
Other
Do you have any existing business loans?
*
Yes
No
Existing Loans
Loan 1 Company Name
Loan 1 Existing Balance
Loan 2 Company Name
Loan 2 Existing Balance
Loan 3 Company Name
Loan 3 Existing Balance
Loan 4 Company Name
Loan 4 Existing Balance
Loan 5 Company Name
Loan 5 Existing Balance
Loan 6 Company Name
Loan 6 Existing Balance
2. OWNER INFORMATION
OWNER #1
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number (SSN)
*
Percentage of Ownership
*
Home Address
*
City
*
State
*
ZIP Code
*
Phone Number
*
Format: (000) 000-0000.
Email Address
*
example@example.com
OWNER #2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number (SSN)
Percentage of Ownership
Home Address
City
State
ZIP Code
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
3. DOCUMENTS TO UPLOAD CHECKLIST
Please upload clear copies of the following document. Only PDF, JPEG, or PNG files. accepted.
Last 4 Months Business Bank Statements
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4. AUTHORIZATION & ACKNOWLEDGMENT
I certify that the information provided in this application is true and accurate to the best of my knowledge. I authorize BizLoan Capital LLC to review my information and share it with trusted funding partners solely for the purpose of evaluating available business funding options.
Owner Signature
*
Printed Name
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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For: INTERNAL USE ONLY Received By: Date Received: Docs Received:
Should be Empty: