info@academyofbusinesscredit.

com
ons, Inc
(800) 634-6025
Only forms completed in its ENTIRETY will be considered.
Signatures of ALL owners are required on Page 2
Boxes in red are REQUIRED
LOAN REQUEST SUMMARY
Loan Amount Requested: Use of Proceeds: ☐ Working Capital ☐ Debt Consolidation ☐ Other:
Debt to be Consolidated:
BUSINESS INFORMATION
Legal Corporate Name: EIN#
DBA Phone Fax
Street Address
City State Zip County
Date Business Started Length of Ownership: Website:
Business Description # of Employees
State of Incorporation: Type of Entity: (check) ☐ Corporation ☐ Sole Proprietor ☐ Partnership
Gross Revenue: YTD 2015 2016 Projected 2017
Net Operating Income: YTD 2015 2016 Projected 2017
Please describe previous efforts to secure funding. If declined, why?

BORROWER/OWNER INFORMATION #1 Will be a guarantor: ☐ Yes ☐ No

(If there are additional owners with 20% or more ownership, provide the same information on a separate sheet of paper
Name: Position/Title: Ownership %: Annual Income:
% Own
Home Address: City: State Zip
SSN: DOB: Phone #: Email:
Credit Score: In the last 7 years check if you had a: ☐ Bankruptcy ☐ Judgment ☐ Lien ☐ Foreclosure
BORROWER/OWNER INFORMATION #2 Will be a guarantor: ☐ Yes ☐ No
Name: Position/Title: Ownership %: Annual Income:
% Own
Home Address: City: State Zip
SSN: DOB: Phone # Email:
Credit Score: In the last 7 years check if you had a: ☐ Bankruptcy ☐ Judgment ☐ Lien ☐ Foreclosure
BORROWER/OWNER INFORMATION #3 Will be a guarantor: ☐ Yes ☐ No
Name: Position/Title: Ownership %: Annual Income:
% Own
Home Address: City: State Zip
SSN: DOB: Phone # Email:
Credit Score: In the last 7 years check if you had a: ☐ Bankruptcy ☐ Judgment ☐ Lien ☐ Foreclosure
REAL ESTATE ASSETS/COLLATERAL Use separate sheet if necessary (* If leased, a rent roll will be required)
Address Date Purchased: Purchase Price Current Value Amount Owed:

Name of the deed holder: Owner Occupied: ☐ Yes ☐ No Leased*: ☐ Yes ☐ No

In the past three years, check if you have filed an insurance claim on the above property for: ☐ Fire ☐ Storm damage ☐ Flooding
BRIEFLY DESCRIBE YOUR PROJECT & THE REASON FOR YOUR LOAN REQUEST or attach business plan/feasibility study

-- SIGNATURES ON NEXT PAGE--

My signature below, attests that: 1) I am a principal or guarantor on the above loan request, 2) the above information is accurate, and
3) authorizes Academy of Business Credit & Funding, its designee, assigns or potential assigns, to review his/her personal credit profile
provided by national credit bureaus in considering this application and for the purpose of the update, renewal or extension of credit to the
applicant or the collection of any resultant accounts. A fax or photocopy of this authorization shall be as valid as the original.

Applicant Signature Printed Name Date

Co- Applicant Signature Printed Name Date

Co- Applicant Signature Printed Name Date

Co- Applicant Signature Printed Name Date

If not already provided, please submit your business plan and/or Executive Summary with this application.