• Business Information

• Legal Name as filed with Secretary of State and DBA if applicable:*
• Legal Form of Business Operation*
  CorporationLLCPartnershipProprietorshipOther
• Contact Person:*
• Email address:*
• Office Phone:*
• Cell:*
• Fax:
• Business Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Company Website
• Federal Tax ID:*
• State of Incorporation or Organization:
  State / Province / Region
• Fiscal Year End:
  MM slash DD slash YYYY
• Taxes current?*
  • Yes
  • No
• How much funding are you requesting?*
  Not Sure$0-$100,000$100,001-$250,000$250,001-$500,000$500,001-$750,000Over $750,000

• Ownership and Management Information

     For Partnership, list Owners and/or Partners with greater than 20% interest. If there are more than two, remaining Owners and/or Partners can be given at a later date.

• Owner 1 Name:*
• Title:*
• Owner 1 % Ownership:*
  Please enter a number from 1 to 100.
• Owner 1 Home Address:*
  Street Address City State / Province / Region ZIP / Postal Code
• Owner 1 Residence:*
  • Rent
  • Own
• Owner 1 Phone*
• Owner 1 Date of Birth:*
  MM slash DD slash YYYY
• Owner 1 Social Security Number:*
• Owner 1 Driver’s License (State & No.):*
• Owner 2 Name:*
• Owner 2 Title:*
• Owner 2 % Ownership:*
  Please enter a number from 1 to 100.
• Owner 2 Home Address:*
  Street Address City State / Province / Region ZIP / Postal Code
• Owner 2 Residence:*
  • Rent
  • Own
• Owner 2 Phone*
• Owner 2 Date of Birth:*
  MM slash DD slash YYYY
• Owner 2 Social Security Number:*
• Owner 2 Driver’s License (State & No.):*

Statement/Authorization

By submitting this form, you agree that you are authorized to execute this Application on behalf of the business name above, and all information set forth herein or otherwise provided is complete, true and correct. Additionally, you hereby authorize Cash Flow Resources, L.L.C to verify any or all of these statements in any way it may choose and has the right to procure all business credit reports, inquiries to the Internal Revenue Service and credit reports of the principles of the applicant company.

Additional financial and/or company information will be required before closing.