Owner | Principal Information

Name

Social Security #

Date of Birth

Home Address

Do you own home? Please Select Yes No

More than 2 years? Please Select Yes No

Mobile

Email

% of Ownership

Annual Income

Value of Retirement, Bank & Brokerage Account

Driver License Number

State Of Issue

Select State Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY)

Expiration Date

Business Information

Business Description

Renter or Owned Please Select Renter Owned

Rent/Mortgage Amount

Landlord/Mortgage Company Contact

Open Bankruptcy? Please Select Yes No

Any Open Judgments? Please Select Yes No

Any Tax Liens? Please Select Yes No

Do you currently have any loans? If yes, what kinds and what is the balance?

Explain changes in Sales/Profit, or Debt (+/–10%)

How much Capital is being requested?

Repayment Terms Please Select Daily Weekly Monthly

Credit Card Montly volume

Total Monthly Sales (All Forms of Revenue)

Gross Annual Sales (Last year's Tax Return)

Number of Customers

What are your business growth plans for the next 3 to 5 years?

Broker? (Who referred you to us?)

By signing this form, you are providing written instructions to LNS Group LLC/LNS Capital Partners under the Fair Credit Reporting Act

authorizing LNS Group/LNS Capital Partners to obtain from your personal credit profile or other information from MicroBilt.

You authorize LNS Group/LNS Capital Partners to obtain such information solely to conduct a pre-qualification for credit. Credit information accessed for my pre-qualification request may be different than the Credit Information accessed by a credit grantor on a date after the date of my original pre-qualification request. Print Name

Date

Please upload:

• 3 current months Bank statements (all pages)
• Drivers License
• EIN Letter
• Corporate Formation Documents

Browse Files

No files selected

Note: All fields Are Required on this Application before Submission.

Click here to sign