Business Financing Request

Business Financing Request
Applicant Name

First NameLast Name
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Owner
Approximate Credit Score
SSN/SIN:
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business Legal Corporate Name
DBA (Doing Business As Name)
Website
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Type

Other
Is Your Business Primarily
Industry
Ownership % In Company
Federal Business Number
Date Business Stated

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How Many Locations
Payment Processing: Credit Cards Accepted
How much funding does your business require:
Reason for financing

Other
If you want to give more detailed information, write here.
How soon do you need funding? Are there deadlines to be aware of?
Have you applied with another lender yet?
Do you have Any Short term loans?
Lender Name and Balance or Hold Back from all Loans
Accounts Receivables Balance
Is the business currently Factoring?
Average Gross Monthly Sales
Please Upload 6 Months of Business Banking Statements

Cancelof
Landlord Contact (If your business is leasing the space)
Landlord Phone Number
Monthly Rent
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
By signing below, the merchant and it's principals 1) certify that all information on and documents submitted in connection with this application and true, correct, and complete; and (2) authorize Atkinson & Dougal, partners, lenders, and it's agents to recieve credit reports and any other information regarding the merchant and it's owners/principals from third parties, in order to verify any information provided on the application.

I agree that my digital signature below will be held as a legal authorized signature. Filling out an applicaton does not guarantee an approval at any time.
I agree that the information herein are true and correct
Email
example@example.com
Signature
Should be Empty: