Loan Application Form – grimstonecapital.org

Loan Application Form (#3)

Essential Information Overview

Business Information

Legal Company Name

Business Start Date

Doing Business as (DBA)

- Select Legal Entity-

Federal Tax ID

City

State

Zip Code

- Rent or Own-

Landloard Name

Landloard Contact

Address Line 1

Address Line 2

City

State

Zip Code

Country

Required For Recommended Loan Amount

Annual Business Revenue

Average Bank Balance

Monthly Credit Card Volume

Loan Amount Requested

Outstanding Balance

Merchant/Owner Information

First Name

Middle Name

Last Name

E-mail of Applicant

Phone number of Applicant

Mobile Phone number of Appliicant

Ownership %

Credit Score

Date of Birth of Applicant

Social Security Number(SSN)

Address of Applicant

Address Line 1

Address Line 2

City

State

Zip Code

Country

Address of Business

Address Line 3

City

State

Zip Code

Country

Partner Information

First Name

Middle Name

Last Name

E-mail of Applicant

Phone number of Applicant Partner

Mobile number of Applicant Partner

Ownership %

Date of Birth of Applicant

Social Security Number(SSN)

Address of Applicant Partner

Address Line 1

Address Line 2

City

State

Zip Code

Country

Is Your Business Seasonal?

Any Open Bankruptcies?

Any Judgements/Liens?

If you are applying for individual credit in your name and are relying on your own income or assets and not the income of assets of another person as the basis for repayment complete Owner Information (1) and omit Owner Information (2).

If this is an application for joint credit with another person, complete Owner Information (1) and (2).

The information provided in this application shall not be shared to anyone else and is kept confidential

I agree that the information herein are true and correct

(646) 791-9296

Essential Information Overview

Required For Recommended Loan Amount

Merchant/Owner Information

Partner Information

Contact

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