PBC Private Lender Application Form

PBC Private Lender Application Form

NO CREDIT CHECK IS REQUIRED. Apply for loan pre-approval up to $500,000. Please complete all required fields, review the authorization and disclaimer sections, and pay the required $250 application package & submission fee before our review.
LOAN REQUEST DETAILS
Loan Amount Requested
Is your need Personal or Business?
If Business, what is the business need type?

Other
Legal Business Name
Personal name if new business
Federal Tax ID (EIN)
Last 4 digits of social security number acceptable
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Email
example@example.com
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Nature of Business
Years in Business/Start-up?
Legal Entity Type
Gross Annual Revenue (Last Year)
Enter '0' for New Business
Projected Annual Revenue (This Year)
Purpose of Funds
Real Estate Loan Request

This section is for real estate investors only
Property Address (For Real Estate Investors Only)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are You Seeking 100% Funding?
Purchase Price
Rehab Budget
Estimated ARV
Amount Needed for Deposit/GAP
Closing Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Property Description
SFH, Condo, Multi-Unit, Commercial, Vacant Land, Mixed Use
Employment and Income Information
Current Employer / Business
Position / Title
Length of Employment / Time in Business (Years)
Monthly Gross Income*
Additional Income Sources (if any)
Financial History and Obligations
Have you had any bankruptcies, foreclosures, or liens in the last 6 months?
Monthly Debt Obligations (approximate total)
Owner 1 Information
Full Name

First NameLast Name
% of Business Owned
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you a US Citizen?
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Owner 2 Information
Full Name

First NameLast Name
% of Business Owned
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you a US Citizen?
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Application Acknowledgment
By submitting this application, you certify that all information provided is true and correct.
Signer 1 Name

First NameLast Name
Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Signer 2 Name

First NameLast Name
Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Application Fee Payment Acknowledgment
I understand the $250 application packaging fee is non-refundable
I approve Pure Business Capital to email me a separate invoice for the $250 fee
DISCLAIMER
This is a pre-approval application only and does not constitute a final loan approval, a loan offer, or a binding commitment to lend. No credit check is performed at this stage. All information provided is used solely to determine preliminary eligibility. Final approval is subject to verification of all details and any additional requirements. Interest rates, fees, and terms are determined upon full underwriting. Funding is provided by Pure Business Capital, Inc. or its partner lenders. This application is not a guarantee of funding. By submitting this form, you authorize us to contact you regarding your request and to verify the information you provide. You represent that all information is true and accurate to the best of your knowledge.
Privacy Notice
Your information is kept confidential and used only for the purpose of processing your loan request.
Next Steps After Submission
1. You will receive a confirmation email.

2. Our team will review your pre-approval request (typically within 1–2 business days).

3. If pre-approved, you will be contacted to submit full documentation for final underwriting.

4. Upon final approval, funding can occur as quickly as 24–48 hours via ACH to your verified bank account.
Should be Empty:

PBC Private Lender Application Form

Real Estate Loan Request

Employment and Income Information

Financial History and Obligations

Owner 1 Information

Owner 2 Information

Application Fee Payment Acknowledgment

DISCLAIMER

Privacy Notice

Next Steps After Submission