Food and Beverage Financing
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Credit Application

Merchant Information

Contact Name:

Position:

Phone:

Fax:

Physical Address:

City: State: Zip:
 

Mailing Address/Billing Address:

City: State: Zip:
 

State of Incorporation/Organization:

Specific Type of Business:

E-Mail Address

Web Address

 

Type of Entity: (check one)
Corporation
Limited Liability Company
Partnership
Limited Partnership
Limited Liability Partnership
Sole Proprietorship

Merchant's Legal Name:

D/B/A:

Federal ID:

Amount Requested:

Use of Proceeds:

Date Business Started: (mm/yy)

Length of Ownership:

Describe Specific Type of Product/Service Sold:


Principal No. 1

Name:

Date of Birth:

Position:

Percentage of Ownership:

Home Phone:

Cell Phone:

Residence Address:

City: State: Zip:
 

Length at Current Residence:

Prior Address, City, State, Zip, if at Current Address less than 2 Years:


Principal No. 2

Name:

Date of Birth:

Position:

Percentage of Ownership:

Home Phone:

Cell Phone:

Residence Address:

City: State: Zip:
 

Length at Current Residence:

Prior Address, City, State, Zip, if at Current Address less than 2 Years:


Credit Card/Terminal Information

Total Gross Monthly Volume:

Total Annual Gross Volume:

Annual Visa/MC Sales:

Visa/MC Monthly Volume:

Credit Card Processing Company

# of Terminals:

Terminal Make & Model:

American Express Yes No

American Express Account #:

Software Type/POS System:

Contact Name & Phone:


Bank Information

Bank Name:

Phone Number:

City: State: Zip:
 

Trade References

Company:

Contact Name:

Company:

Contact Name:

Company:

Contact Name:

Phone Number:

Fax:

Phone Number:

Fax:

Phone Number:

Fax:


Building Information

Own/Lease:

Lease Start Date:

Lease Term:

Monthly Rent/Mortgage:

Type of Building:

Square Feet (approximate):

Landlord/Mortgage Company:

Contact Name:

Phone Number:

Fax:


         
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