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BUSINESS INFORMATION

Company NameBusiness Phone

Business Address

CityStateZip

Amount RequestedEIN NumberDate of incorporation

Type of Organization (LLC, LLP, S-Corp, Non-Profit)Type of Business

OWNER 1

Full Legal Name*

First NameMiddle InitialLast Name

Title* Ownership %*SSN Number*

Phone (Home)Phone (Cell) Date of Birth*

Email Address*

Home Address*

Address

CityStateZip

OWNER 2* (IF APPLICABLE)

Full Legal Name

First Name Middle InitialLast Name

TitleOwnership %SSN Number

Phone (Home)Phone (Cell) Date of Birth

Email Address

Home Address

Address

CityStateZip

FINANCIAL NEEDS

Describe what your financial needs are. Please be specific.*

Terms of FinancingPurchase Price

Has Any Owner/Officer filed Bankruptcy in the last 5 Years?*YesNo

Do you have collateral that you would like to pledge?YesNo

If so, please describe items with estimated value:

Business Articles & EIN

Articles of incorporation:

EIN Letter:

FINANCIAL DOCUMENTS* (IF APPLICABLE)

Uploading your financial documents will speed up your loan process. Please upload the following:

Most recent business bank statements – 3 months
Most recent business and personal tax returns – 2 years
Most recent 1099 (if applicable)
Current business profit & loss statement and financial statement
Credit report (if available)

File 1:

File 2:

File 3:

File 4:

File 5:

By signing above I/We certify that the information above is true and understand that making false statements might be considered fraud. Applicant named above hereby authorizes Tier One Capital and it's affiliates, assigns, agents, banks or financial institution to obtain and view a credit report submitted by applicant.

BUSINESS INFORMATION

OWNER 1

Full Legal Name*

Home Address*

OWNER 2* (IF APPLICABLE)

Full Legal Name

Home Address

FINANCIAL NEEDS

Business Articles & EIN

FINANCIAL DOCUMENTS* (IF APPLICABLE)

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