Requesting Financing for a Business Loan

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Contact Information
Company
Address
 
Contact Name:
Telephone Number:
Mobile Number:
Fax Number:
E-mail:
   
Personal Information  
Personal Monthly Income:
Employer
Date of Birth
   
Assets
Description
 Value

Checking Account/Bank Name

Savings Account/Bank Name

Stocks & Bonds

Real Estate - Home (Market Value)

Other Real Estate

Vested Interest in Retirement Fund

Net Worth of Business(es)

Automobile(s)

Other Assets
Asset Total Value
Liabilites
Description
Unpaid Balance
Monthly Payment / Months Left

Rent/Mortgage

Automobile

Credit Cards

Other Loans
Total Liabilities
Net Worth (Assets - Liabilities)

What is the loan for:
If other please specify:
Project Name:
Date:
Pending Deadlines
Borrower Name:
No. of years in Business:
   
Property Information      
Address:
 
Legal Description:
   
Business Finance Information
Requested Loan Amount:
Down Payment Available:
Collateral for Loan:
Estimated Value:
Purpose for Loan: Land Acquisistion
  Construction
  Permanent
  Business Expansion
  Operating Expenses
  Other Specify:
Project Summary
Plan of Repayment:
Length of Loan and Desired Term:
       

By submitting this application, the Applicant certifies the information provided is accurate and allows Connect To Capital consent to access information for the purpose of obtaining financing.

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