Line of Credit Intake Form

Applicant Information

Business Name *

Applicant's Full Name *

Title/Position *

Business Address *

Direct Phone Number *

Email Address *

Website

Type of Business Entity *

Other Type of Business Entity *

Industry *

Date Established *

Annual Revenue *

Number of Employees *

Requested Line of Credit Amount *

Other Purposes of the Line of Credit *

Do you have any existing credit facilities? *

Yes

No

Could you please provide details on existing credit facilities? *

Bank Statements for the last 3 months and up to 12 months *

Drivers License *

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