Applicant Warrants All Credit and Financial Information Submitted to Yale Business Capital

YaleBusinessCapital.com / APPLICATION / Company: Yale Business Capital
Phone: 954-755-6169
PLEASE PRINT LEGIBLY AND FILL OUT COMPLETELY / Fax: 888-745-0913
Email:
Representative:
BUSINESS INFORMATION / Use of loan proceeds: / Loan Amount: / Today’s Date:
Legal Business Name:: (for Sole Proprietorships, enter Principal’s name): / d/b/a Name (doing business as name:
Business Location Address: (No P.O. Box) / City: / State: / Zip Code:
Time In Business
Years Months / Time In Business (under same ownership):
Years Months / How Long At Current Location:
Years Months / Number of Locations:
Federal Tax ID #: / State of Incorporation: / Type of Goods/services sold: / Professional/Medical License #:
Type of Ownership:
Sole Proprietorship Partnership Other:
Corporation Limited Liability Corporation
Total Annual Gross Sales: / Total Annual Portion of Credit Card Sales:
$ / Total Annual Portion of Check Sales:
$
Business Phone: / Business Fax: / Cell Phone: / Email: / Website:
PRINCIPLE 1 / Legal Name: / Title: / % of Ownership: / Home Phone:
Residence Address: Own Rent / City: / State: / Zip Code:
Social Security #: / Date of Birth: / Driver’s License #:
PRINCIPLE 2 / Legal Name: / Title: / % of Ownership: / Home Phone:
Residence Address: Own Rent / City: / State: / Zip Code:
Social Security #: / Date of Birth: / Driver’s License #:
BANK / Bank Name: / Contact: / Phone: / Fax: / Email:
Routing/ABA Number: / Account/DDA Number:
REFERENCES / Business Reference 1: / Contact: / Phone: / Fax:
Business Reference 2: / Contact: / Phone: / Fax:
Business Reference 3: / Contact: / Phone: / Fax:
Business Reference 4: / Contact: / Phone: / Fax:
PROPERTY / Property Ownership Status:
Own Lease / Landlord / Mortgage Company Name: / Phone: / Fax:
State Date: / Lease/Mortgage Term: / Monthly Rent/Mortgage Payment:
$ / Square Footage:
Type of Building:
Storefront Condominium Home Other:

Applicant warrants all credit and financial information submitted to Yale Business Capital and/or its assignees to be true and accurate and hereby authorizes all banking institutions, income tax reporting agencies and credit reporting agencies to release necessary information via telephone, mail, Internet or facsimile as requested for purposes of making a credit decision. The undersigned individuals specifically authorize Yale Business Capital and/or its assigns to obtain personal credit bureau reports and/or personal and business income tax transcripts for the making, extension, or renewal of this credit decision or collection of the resulting account. A fax or photocopy of this authorization shall be valid as the original.

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Authorized Signature / Date / Authorized Signature / Date