Requesting Financing

Your information is confidential. We will not sell or disclose your private information.

Date of Request:
Date Funds Required:
Name of Borrower:
Contact Name:
Address
  City: State: Zip:
Work Phone Number:
Cell Number:
Fax Number:
Primary E-mail Address:
Requested Loan Amount :
Term (No. of Months)
Property Address
  City: State: Zip:
     
Are there any judgments or lawsuits filed against you or your business/company? If so, please explain.

Appraisal Value

Collateral
Repairs Needed? If so, please explain.

Repair Estimate (if applicable)

Description of Needs

    
Notes    

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.

Respecting and protecting customer privacy is vital to our business; thus, the Applicant is encouraged to read our Privacy Policy so the Applicant will better understand how Connect To Capital keeps customer information private and secure while using it to serve the Applicant better.