PRINCIPAL NAME: 

Title:                      

Company Name:    

Street Name:         

Town:      County:       Postal Code:   

Telephone:         Mobile Phone: 

Fax:                     E-mail: 

Start-up           Existing Business          Years in Business 

Sole Proprietorship          Partnership          Corporatio

Industry: 

Amount of Financing Requested: 

Purpose of Financing:

            Franchise Purchase          Equipment Financing         Start-up Financing 

            Working Capital          Receivable Financing          Factoring         Property Finance 

            Other:

Briefly Describe purpose of Financing:  

Personal Guarantees Available:    Yes          No 

Credit History of Owner:    Excellent          Satisfactory         Poor

Credit History of Company:    Excellent     Satisfactory          Poor

If a Business Purchase:    Purchase Price 

Cash Invested by Buyer 

Total Business Assets

Total Business Liabilities 

Total Business Net Worth 

Company's Annual Revenue 

Company's Annual Net Profit 

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