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✓ See if you pre-qualify for
working capital
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Borrow up to $250,000 • Secured & Unsecured Options Available
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Business
2
Banks and Balances
3
Personal
4
Mortgage and Landlord
5
Credit Release Authorization
Legal Business Name
*
Business Entity Type
*
Please Verify
Assumed Business Name (ABN/DBA)
Corporation (Inc.)
Limited Liability Company (LLC)
Partnership
Sole Proprietorship (Individual)
Unsure
Business Address
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Business Phone
*
Fax Number
Federal Tax ID #:
How Many Years Have You Been in Business Under This Legal Name and Ownership?
*
Please enter a number less than or equal to
99
.
What Do You Deposit Through Your Business Account Monthly?
*
How Much Is In Your Business Bank Account Today?
*
What Do You Process in Monthly Credit Card Sales?
*
What Are Your Gross Annual Revenues?
*
Do you currently have an open Merchant Cash Advance or Working Capital Loan?
*
Yes
No
What is Your Total Balance Owed On Other Merchant Cash Advance or Working Capital Loans?
How Many NSF's or Overdrafts Have You Had Out Of Your Business Account In The Last Three (3) Months?
*
Please Confirm
0
1
2-3
4 or More
Primary Owner Name
*
First
Last
Title
*
What would you estimate your personal credit score to be?
*
Confirm Score Range
Excellent (750+)
Very Good (700-749)
Good (650-699)
Fair (600-649)
Poor (Below 600)
Social Security Number
*
Date of Birth
*
MM
DD
YYYY
Email
*
Home Address
*
Same as Business
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Drivers License Number
*
State of Issue
*
Please Confirm
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Annual Salary (or Income)
*
Amount of Working Capital Requested
*
Purpose of Working Capital
Please Confirm Need
Need to Purchase Equipment
Need to Purchase Inventory
Need to Repair Some Equipment
Other
Need it to Pay Payroll
Need it to Pay Taxes
Please Specify Reason for Working Capital
*
Estimated Pre-Approval Number
Additional Owner Information
Does Your Business Have Other Owners?
*
Please Confirm
Yes
No
Owner #2:
Name/Title/Percentage of Ownership
Owner #3:
Name/Title/Percentage of Ownership
Owner #4:
Name/Title/Percentage of Ownership
Landlord/Mortgage Information
Landlord/Mortgage Company Name
*
Home Ownership
*
Own
Rent
Rent/Mortgage Payment
*
Lease Start Date
Date Format: MM slash DD slash YYYY
Lease Term
Landlord Contact Name
First
Last
Landlord or Mortgage Company Phone Number
*
Which Sales Rep Referred You?
*
None OR Other
Brian Kirlin
Brock Kimball
Derek Anniston
Doug Fuller
George Vandel
Katana Willett
Mariah Castaneda
Maria Ehlers
Yadi Anniston
Consent for Credit Release Authorization
*
I Agree
I (We) authorize Security Leasing Services, Inc. (aka SLS Financial Services), American Equipment Financial Services, LLC, American Leasing & Financial, Opportunity Financial Services, LLC, and/or its assigns and designees to investigate all credit information, including but not limited to consumer credit reports, bank and trade references and accountant information for purposes of processing this lease credit application. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. All principals hereto agree that an electronic copy of this application may be treated as and considered the same as an original. By choosing the Submit For Approval button below, you are giving your electronic signature in agreement with these terms. By providing your contact information, you agree to receive electronic communications from SLS. I (We) certify that the above information provided is true and correct.
ECOA NOTICE (TO BE RETAINED BY APPLICANT) Thank you for your business credit application. We will review it carefully and get back to you promptly. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain that statement, please contact us within 60 days from the date that you are notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of your request for the statement. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers our compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.
By checking the "I Agree" box and typing my name as Digital Signature, I am indicating the above statements are true and accurate to the best of my knowledge. I hereby agree to the Credit Release Authorization and Verification Terms and Conditions, understanding it may be necessary to complete a review of my credit PRIOR TO receiving terms and payment options.
I hereby agree that this agreement may be electronically signed and that my digital signature appearing on this agreement is the same as a handwritten signature for purposes of validity, enforceability, and admissibility.
Type Your Full Legal Name