Company Name/Logo
BUSINESS LINE OF CREDIT APPLICATION
APPLICANT INFORMATION
Applicant Name: Date of Birth: Social Security Number:
Co-Applicant Name: Date of Birth: Social Security Number:
Address: City, State, Zip:
Phone Number: Email Address:
Driver’s License #: State of Issue: Expiration Date:
BUSINESS INFORMATION
Business Legal Name: Taxpayer ID: Business Status:
New Existing
Business Type:
Individual Partnership Corporation Non-Profit Other
Names of Owners: Years in Business: # of Employees:
Business Address: City, State, Zip:
Business Description:
LINE OF CREDIT REQUEST
Line of Credit Type: Amount Requested:
Secured Unsecured
Use of Funds Description:
FINANCIAL INFORMATION
Business Asset Accounts: Business Liability Accounts:
Financial Institution Balance Creditor Amount
TOTAL TOTAL
Annual Sales: Annual Net Income:
ADDITIONAL INFORMATION
Has the applicant declared bankruptcy in the past 7 years? Yes No
Are there any pending claims or lawsuits against the applicant or the business? Yes No
Are there any liens filed against the applicant or the business? Yes No
Are any assets currently pledged against the business? Yes No
AUTHORIZATION/SIGNATURES
I certify that the information provided above is accurate to the best of my knowledge and I authorize [Company Name] to obtain
credit and employment information in order to determine my eligibility for the requested business line of credit.
Applicant Name (Print): Applicant Name (Signature): Date:
Co-Applicant Name (Print): Applicant Name (Signature): Date:
Please attach a copy of your financial statements and tax returns for the past 3 years and current full year financial
projections.
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