Step
1: Complete this application fully, Print the application and then
Sign it.
Step 2: Fax to 1-845-622-3805
or
Mail to: Online Corporate Loans, 58 Taylor Rd., Patterson, NY
12563
Financing Application Form
COMPANY
Information:
Loan Amount Requested:
$
Company Name:
Company Address:
City:
State:
Zip:
Website Address:
Email:
Phone #:
Fax #:
Business Industry:
Years in Business:
Tax ID #:
Annual Revenues:
$
Net Income: (current
year)
$
Net Income: (previous
year)
$
Rent / Lease:
$
Number of Employees:
Dun & Bradstreet # (if
applicable)
Type of Company (Inc.,
LLC, Sub S)
OWNER Information:
All owners with 20% or greater
interest.
Use seperate sheet if necessary
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Citizenship:
SSN:
Country of Birth:
Driver License or Passport:
State or Country:
Home Phone #:
Work Phone #:
% Ownership:
Owner Salary / Draw:
$
State:
Zip:
Does owner have 20% or
greater ownership in another business:
2ND OWNER Information: (if
applicable)
All owners with 20% or greater
interest.
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Citizenship:
SSN:
Country of Birth:
Driver License or Passport:
State or Country:
Home Phone #:
Work Phone #:
% Ownership:
Owner Salary / Draw:
$
State:
Zip:
Does owner have 20% or
greater ownership in another business:
OTHER Information:
Company Total Assets:
$
Company Total Liabilities:
$
Company Total Equity:
$
Company Total Net Worth:
$
How many years tax returns do
you have?
Income Tax Form #:
Bank Name:
Account Type:
Bank City State:
Average Balance:
Bank Phone Number
Bank Contact Person:
Total Project
Costs: $
Total Owner Contribution: $
Source of Contribution:
Is this company Public or
Private?
Public
Private
Does any owner have 20% or
greater ownership in another business? If YES, give the name of
owner and total sales of that business?
Yes
No
OTHER Debt:
Other Loan / Debt Outstanding: $
Interest Paid on Debt Outstanding: $
Will this other loan/debt be paid off
with proceeds from this financing request?
Yes
No
Please
give the name and addresses of bank holding this debt:
Bank Name
Bank Address:
City:
State:
Zip:
Contact Person:
Current Balance:
$
Commitment Amount:
$
Monthly Payment:
$
HOW DID YOU
FIND US:
Declaration:
All owners authorize Online
Corporate Loans to request a credit report.
I have read answered
all questions as completely and truthfully as possible.
DISCLOSURE
OF TERMS
The
undersigned individuals agree that Online Corporate Loans or any of
its related entities, partners or affiliates
may obtain
a credit report on the undersigned and/or the
undersigned's business and
subsequent reports in the future when
necessary. The undersigned agrees that this application
will remain property of Online Corporate
Loans and that they may exchange this
information with other
companies, while attempting to
establish financing, whether or not
financing is granted. The undersigned agrees
not to hold Online Corporate Loans or any of
its related entities, partners or affiliates
liable for
any matter in relation to the information in
this application or any subsequent
issues that may arise as a result of
acquiring or not acquiring financing.
The undersigned affirms that they fully
understand all aspects of this application
and of this disclosure.
The undersigned further affirms that they have
completed this application truthfully and
that all information represented on this
application is correct.