Business Credit Application – Southwest Credit

Company Name

The legal name of your business

Business Structure

The formation structure of your business

Industry Industry

The general industry of your business.

Federal Tax ID

TIN or EIN

D&B

Dun & Bradstreet Identification Number

Date Established

Date Incorporated

State incorporated

Permanent Employees

Describe Your Business

Annual Sales

$

Company Contact Information

Business Phone

Fax

Website/URL

County

Main Address

Street Number and Name

Apt, Suite, or Unit

City

State/Province

Zip/Postal

Subsidiaries or Multiple Locations?

Yes

No

You will receive an email requesting additional information on your subsidiaries and/or additional locations.

Does the business own real estate?

Yes

No

You will receive an email requesting additional information regarding the business real estate ownership.

Is your business space leased?

Yes

No

Primary Contact Information

Please provide information on the primary contact for this application

Name

First

Last

Phone

Email

SSN

Date of Birth

Home Address

City

State/Province

Zip/Postal

Purpose and amounts

Equipment Financing

Equipment Leasing

Replacing or Adding Equipment?

Replacing Equipment

Adding Equipment

Equipment Financing Amount

$

AR Financing

Accounts Receivables Financing

Factoring

AR Financing Amount

$

Cash Based Financing

Cashflow Financing

Merchant Financing

Cash Based Financing Amount

$

SBA Financing

SBA Financing Amount

$

Real Estate Financing

Real Estate Financing Amount

$

Please tell us a little about what you will use the financing for.

Authorization to Obtain Credit

By signing below, each undersigned individual who is either a principal of the finance/lease application listed below or a personal guarantor of its obligations, provides written instruction to Lender or its Designee (and any Assignee or Potential Assignee thereof) authorizing the review of his/her credit profile considering the application of the credit application and subsequently for the purpose of updating, renewal, or extension of such credit and for reviewing or collecting the resulting account. A photocopy or facsimile of this authorization shall be valid as the original. in addition to authorizing review of My/Our credit profile from any national credit bureau, the undersigned also authorizes My/Our financial institutions and creditors to release credit information required by Lesser or its Designee (and any Assignee or Potential thereof).

Signature

Clear

Please indicate the supplemental data that you have to report. More information increases your potential of approval.

Client Referrals

Supplier Referrals

Do you have Debt to Report?

Does the business own any Real Estate?

Do you have any paid for equipment?

Due to your business structure, you will be required to submit information regarding your company’s principal owners.