Financial Funders Unlimited

BUSINESS CREDIT APPLICATION

INSTRUCTIONS: PLEASE COMPLETE ALL SECTIONS. PERSONAL GUARANTOR MUST ALSO COMPLETE INDIVIDUAL CREDIT APPLICATION. PLEASE INCLUDE CURRENT FINANCIAL STATEMENT, BALANCE SHEET, AND INCOME AND EXPENSE STATEMENT ON THIS BUSINESS.

BUSINESS INFORMATION - CREDIT LIMIT REQUEST $ *

BUSINESS NAME: *

TAX ID: *

PHONE: *

BUSINESS ORGANIZATION (CHECK ONE):

MAIN ADDRESS: *

CITY: *

STATE/PROVIDENCE: *

ZIP CODE: *

YEARS HERE? *

OTHER LOCATION:

CITY:

STATE/PROVIDENCE:

ZIP CODE:

YEARS HERE?

MANAGEMENT/OFFICER: *

TITLE: *

HOME ADDRESS: *

CITY: *

STATE/PROVIDENCE: *

ZIP CODE: *

YEARS HERE? *

OTHER MANAGEMENT/OFFICER:

TITLE:

HOME ADDRESS:

CITY:

STATE/PROVIDENCE:

ZIP CODE:

YEARS HERE?

BANKING REFERENCE (INCLUDE CHECKING AND LOANS):

NAME & ADDRESS OF BANK(S): *

PHONE: *

CHECK/LOAN? *

YEARS? *

BALANCE: $ *

ACCOUNT NUMBER: *

TRADE REFERENCES:

NAME & ADDRESS OF TRADE ACCOUNT: *

PHONE: *

CONTACT: *

ADDITIONAL INFORMATION:

TYPE OF BUSINESS: *

YEAR STARTED? *

DUNS#: *

BANKRUPTCY? YESNO

YEAR?

BUSINESS ACCOUNTANT'S NAME: *

PHONE: *

ADDRESS: *

CITY: *

STATE/PROVIDENCE: *

ZIP CODE: *

YEARS HERE? *

BUSINESS INSURANCE AGENT? *

PHONE: *

ADDRESS: *

CITY: *

STATE/PROVIDENCE: *

ZIP CODE: *

YEARS HERE? *

AUTHORIZED SIGNATURE(S): *

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