The Brokers Application

Capital For Market - BUSINESS LOAN APPLICATION FORM

*Application Type

*Legal Business Name (the “Applicant”)

*Doing Business As (DBA) Name

*Yrs in Business

*Yrs at Location

*Business Address (No P.O. Box)

*City

*State/Province

*ZIP/Postal Code

*Is the Mailing/Billing Address of Applicant different than the above address?

Yes

*Business Phone

Business Fax

Name and Amount of Outstanding Merchant Advance/ Loans

*Type Of Legal Entity – e.g. Corporation, Unlimited Partnership, Partnership, Sole Proprietor

Tax Id/GST/EIN #

OWNER1 – ALL FIELDS COMPULSORY

*Full Name

*Title in Business

*Ownership Percentage

*Date of Birth (mm/dd/yyyy)

SSN/SIN #

*Home Phone Number

*Cell Phone Number

*Home Address

*City

*State/Province

*Email Address

OWNER2 – ALL FIELDS COMPULSORY

Full Name

Title in Business

Ownership Percentage

Date of Birth (mm/dd/yyyy)

SSN/SIN #

Home Phone Number

Cell Phone Number

Home Address

City

State/Province

Email Address

LANDLORD INFORMATION – ALL FIELDS COMPULSORY

*Landlord Company Name

*Contact Name

*Address

*Province

*ZIP/Postal Code

Phone Number

SUPPLIER/TRADE REFERENCE – AT LEAST ONE OF EACH

*Company Name

Company Name

*Contact Name

Contact Name

*Phone

Phone

FINANCIALS & LOAN DETAILS

*Gross Annual Turnover

*Monthly Rent/Mortgage

Monthly Credit/Debit Card Turnover

Expiry Date Of Lease

*Total Monthly Sales

Credit/Debit Card Processor

*Requested Loan Amount

*Purpose of Loan and about your business

FINANCIAL PROFILE

*Any Open Judgement

*Any Bankruptcy

*Any Tax Liens

*Seasonal Business Y/N, Total Peak Months

Emergency Contact – All Fields Compulsory

*Contact Name

*Relationship

*Phone Number

ALL OWNERS MUST SIGN – The undersigned Owner(s): (1) Confirms all details submitted with this application are true,correct and complete (2) permits Capital For Market or any of its agent, partners and affiliate to verify details provided: directly or via third party sources. As well as obtain and use business and non business consumer credit reports from credit reporting agencies and any other information regarding the applicant and its owner(s) from third party sources at the time of the application and while applicant remains a client of Capital For Market (3) Allow Capital For Market to make loan applications on their behalf

*Name Owner 1

*Signature

*Date

Name Owner 2 (Optional)

Signature

Date

IMPORTANT NOTICE: Once you hit the submit button. It will take a few minutes for the system to process your application. So please be patient and do not close this window while the system is processing your application.