New Business Startup Loan Application

New Business Start Up Capital Application

This form is also available as a download which can be faxed to 336-217-8155.
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Start Up New And Growing Businesses

Maximize Cash Flow

Keep Pace With Market Demands

New Business Start Up Capital Application
Amount of Loan:
Purposed Use of Funds:
Business Name:
Phone:
Fax:
Address:
State:
Zip Code:
E-mail Address:
Type of Business:
Business Type:
Years in Business:
Tax I.D. #:
Principal's Name:
Title:
SSN:
Home Address:
Phone:
Principal's Name:
Title:
SSN:
Home Address:
Phone:

(If Physician, Dentist, Veterinarian or Chiropractor, please fill out the following:)
Year Licensed:
State:
License#:

Date Registered:
Bank:
Account #:
Account Type:
Contact:
Phone:
Fax:
(List Previous Bank if At Present Bank Less Than 2 Years)
Bank:
Account #:
Account Type:
Contact:
Phone:
Fax:
Check your funding interest(s):
Debt Restructuring Settlement Financing SBA Express Loans Purchase Order Funding Equipment Financing Consolidation Loan Commercial Mortgage Accts. Receivable Factoring
Additional Comments:

Type of Equipment:
Equipment Cost:
Term:
Equipment Description:
Vendor Company Name:
Contact:
Address:
State:
Zip Code:
Phone:
Fax:
E-Mail:
I authorize you to obtain such information as you may require concerning the statements contained in this application, and agree that the application shall remain your property, whether or not the lease is granted. I hereby certify that all statements contained in this application are true and complete and are made for the purpose of obtaining credit. I agree to notify you of any material changes in the condition of affairs, and this statement shall be construed by you to be a continuing statement of the conditions of the Lessee until written notice to the contrary is received by you. Lessee and its principal authorize the release of credit information to the Lessor.
By: Title: Date: