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ONLINE APPLICATION
*
Required Field
*
Business Name:
Date Business Started:
Street Address:
County:
*
City:
*
State:
*
Zip:
*
Tel:
Fax:
Federal ID Number:
Where did you hear about us:
Select One
Google
Yahoo
MSN
AOL
Superpages
GetLoaded
Other
If Other:
Type of Business:
*
Form of organization:
Sole proprietor
Partnership
Corporation
LLC
State of formation:
Website:
Email:
Number of employees:
PRINCIPALS
*
Required Field
*
Name:
Social Security #:
*
Title:
*
% Own:
*
DOB:
DL #:
*
Home Address:
*
City:
*
State:
*
Zip:
*
Telephone #:
Cell #:
Email:
Spouse's Name:
SSN #:
RECEIVABLE INFORMATION
*
Required Field
Amount of receivables now open:
Average monthly sales $:
Terms of sales:
Average invoice amount $:
Are you factoring now or have you factored before:
Yes
No
If yes, with whom:
Any other commercial loans/leases outstanding:
Yes
No
Amount $:
*
The foregoing statements are true and accurate to the best of my/our knowledge. I/We hereby consent to the release of personal and business information and acknowledge that such information will be useful in qualifying me/us and the business for the requested financing. This authorization may be forwarded to third parties who are hereby authorized to release such information. I/We understand that submission of this application does not commit Winston Financial Group, Inc. to provide any financial services.
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