24 Hour Capital Application
Loan Rep Form
24 Hour Capital Application
Loan Rep Form
Name
BUSINESS INFORMATION
Business Legal Name
*
Doing Business As
*
Legal Entity
*
Federal Tax ID
*
Business Start Date
*
Business Mailing Address
*
Business Mailing City
*
Business Mailing State
*
Business Mailing ZIP
*
Business Physical Address
*
Business Physical City
*
Business Physical State
*
Business Physical ZIP
*
Business Phone
*
Business Email
*
Business Website
*
Monthly Gross Sales
*
Amount Requested
*
Industry Type
*
Business Description
*
Open Bankruptcy?
*
Rent/Mortgage or Own?
*
Monthly Payment
*
Landlord Contact Name
*
Landlord Phone Number
*
Additional Information - current balances of other MCAs, what will $ be used for, etc.?
OWNER INFORMATION
Owner Full Name
*
Owner Home Address
*
Owner Home City
*
Owner Home State
*
Owner Home ZIP
*
Owner DOB
*
Owner Social Security Number
*
% of Ownership
*
Owner Phone Number
*
Owner Email Address
*
FUNDING INFORMATION:
What is the Capital being requested for?
*
Monthly VISA/MC volume
*
Average Transaction amount
*
Average Number of Daily Transactions
*
Monthly Payroll
*
Is the Owner’s Salary Included?
*
YES
NO
Amount of Owner’s salary
*
Was the business purchased from another
YES
NO
If yes, was it financed?
If financed, what is the monthly payment?
Gross Annual Sales from last years tax return
*
Prior or Current Working Capital or Funding?
YES
NO
Funder name and balances
*