1. What is the Name of the Business?

2. What is your name?

3. What is the address of the principal of the business?

4. Type of Entity LLC, Corporation, Etc?

5. Are you 100% owner?

6. Business Type; Product/Service?

7. Date Business Started?

8. Length of Ownership?

9. Use of Proceeds?

10. Web Address?

11. Merchants Name?

12. Date of Birth?

13. Position?

14. Drivers License # and State?

15. Home Phone Number?

16. Cell Phone Number?

17. Residence Address?

18. Avg. Gross Monthly Volume (Cash, Checks, Credit Cards)?

19. Do you have an open loan or merchant cash advance balance?

20. Have you used a loan or merchant cash advance program before?

21. Is there an outstanding loan to a previous business owner?

22. Any state/federal tax liens against owner?

23. Have you or your business ever declared bankruptcy?

24. Are there any suits or judgments pending against you?

25. Do you own or lease the business?

26. Lease start date?

27. Lease Term?

28. Monthly Rent/Mortgage?

29. Square Footage?

30. Landlord/Mortgage Company?

31. Contact Name?

32. Phone Number?