Business Credit Reports

Company Information

Company Name

Website

Address

City

State/Province

Zip/Postal Code

Country

Telephone

Fax

Cellular

Email Address

Year Established

Company Type (C Corp/S Corp./Partnership/Sole Proprietor/etc.)

State of Incorporation

Type of Business

# of Employees

Tax Identification #

Secretary of the Corporation

Use of Funds

How is the Company currently financed? (Self/Bank/Equity/Explain)

Are Any Debts Past Due (Yes/No)

If Yes, Amount Past Due ($)

Name of Creditor(s) Past Due

Are Any Taxes Delinquent? (Yes/No)

If Yes, Amount Past Due ($)

Are any Liens on file? (Yes/No)

If Yes, please describe

Are the Owners, with greater than 20% interest or investment, U.S. Citizens? (Yes/No)

If No, Who are not U.S. Citizens

Contact Information

First Name

Last Name

Title

Phone

Cellular

Fax

Referred By

Professional References

Accountant

Address

Telephone

Fax

Attorney

Address

Telephone

Fax

Business Bank Account Information And Wiring Instructions

Bank Name

Address

City

State

Zip

Account Name

Telephone

Fax

Bank Contact Name

Account # 1

ABA #

Account # 2

Prior Business Locations And/Or Names

Prior Name (if applicable)

State of Incorporation

Address

City

County

State

Owners/Officers/Directors #1

Name

Title

Ownership %

Home Telephone #

Home Address

City

State

Zip

Date of Birth

Driver's License #

State

Social Security #

Owners/Officers/Directors #2

Name

Title

Ownership %

Home Telephone #

Home Address

City

State

Zip

Date of Birth

Driver's License #

State

Social Security #

Owners/Officers/Directors #3

Name

Title

Ownership %

Home Telephone #

Home Address

City

State

Zip

Date of Birth

Driver's License #

State

Social Security #

Owners/Officers/Directors #4

Name

Title

Ownership %

Home Telephone #

Home Address

City

State

Zip

Date of Birth

Driver's License #

State

Social Security #

Request

Requested Amount

Comments (400 characters max)

Terms

In submitting the foregoing application, along with all requested documentation supplied to Asset Commercial Credit, the undersigned guarantees its accuracy with the intent that it be relied upon by Asset Commercial Credit to enter into a financing agreement with the named company and warrants that the undersigned has not knowingly withheld or misstated any material information. The undersigned agrees that it shall notify Asset Commercial Credit, in writing, of any material change in the company’s financial condition or prospects.

It is further agreed and understood that the initial application fee of $500.00 (Five Hundred Dollars) is due and payable with the application by check made out to Asset Commercial Credit and is non-refundable. The undersigned agrees to pay any expenses incurred over and above the application fee, due to credit searches, legal and administrative fees, and/or for other expenses or costs that Asset Commercial Credit may incur in processing the application and administering the financing agreement.

The undersigned hereby authorizes Asset Commercial Credit its affiliates, designated agents or assignees to run business and personal credit inquiries, and to verify any necessary information such as but not limited to, savings, checking accounts, or loan status, payment history verification, including accounts payable, accounts receivable, credit union, mortgage balances, tax payment history and any employment or related compensation verification.

I accept the above terms.

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Submit the Request

By clicking 'Submit', I/We authorize Asset Commercial Credit or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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