* = Required Information

Contact Information

First Name: * Last Name: *

Home Address: Zip:

City: State:

Phone Number: * Home Cell Work Office

Email Address: * Social Security # (only put the last four digits:)

Annual Income Average Bank Balance (mark "x" in appropriate field)

Date of Birth Consultant or Agent Name: *

What is your personal credit score? Applicant is a U.S citizen?

About Your Business

Legal Business Name:

Type of Business (i.e. automotive, restaurant, investment )

Type of Entity: (I.E. S-Corp, LLC) %Ownership

When Did You Incorporate? State Incorporated

Physical Business Address

Company Phone Number: Is number listed? YesNo

Website Address:

Landlord Name Phone Number

How much unsecured business capital are you seeking?

Do you have collateral?

Do you have a loan? YesNo If so what type of loan?

Type of business loan?

Business will be or is a legal "for profit" U.S business?

Business or Individual Applicant is CURRENTLY free of any type of Bankruptcy Proceedings at this time? Exceptions: Past Bankruptcy does not make one ineligible. If you have had a past bankruptcy you may still be eligible for an SBA Loan if over one year ago.

Business or Applicant has Below Average, Average, Fair or Reasonably Good Credit? You should not have more than 5 loan inquiries within the past 90 days. (Note: Perfect Credit is not a Requirement but any negative items appearing on the credit report need to have a written explanation.

What are your average monthly sales/revenue?

What is your monthly volume of credit card sales?

Do you currently have any business credit cards? (If so, please list bank/lender, balance, and credit limit) Yes No

Bank Balance Limit

Others Bank Balance Limit

Do you currently have any other business lines of credit (not business credit cards)? Are they Secured or Unsecured? (If so, please list bank/lender, balance, and credit limit) Yes No

S U Bank Balance Limit

Others S U Bank Balance Limit

Any Merchant Card Advances Cash Flow Analysis

Do you have a 9-digit D-U-N-S Number? YesNo                                               D-U-N-#:

Do you have a Federal Tax Id Number? YesNo                                               FEIN#: (mark "x" in appropriate field)

Do you know your Business Paydex Scores? YesNo                                               Scores: (mark "x" in appropriate field)

How much unsecured business capital are you seeking? $50,000.00- $250,000.00$250,000.00-$500,000.00$500,000.00-$1,000,000.00$1,000,000.00 and above

Upload Documents

Upload Secretary of State Corporate Documents Upload Copy of your IRS E.I.N Documents Upload Copy of your State Tax ID (if applicable) Upload Copy of your personal identification (state I.D.)

Disclosure Agreement

1. I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Client agrees to comply with the terms of non-circumventing of agencies working on its behalf. 2. An application fee of $500 may be charged by the broker for identifying funding resources to include: Bank Cards, Business Credit Cards, Lines of Credit, Loans and Grants.Application submission does not guarantee approval. Approvals are subject to lenders criteria for funding. 3. Applicant authorizes Broker and Lenders and its associates to access the credit reports as required. 4. For pre approval Loan consideration the broker/lender will require you to obtain and supply a copy of your personal credit report (www.truecredit.com) 5. If currently in business a copy of the businesses credit report will be required (www.dnb.com), (Equifax Business Credit Report), (Experian Business Credit Report). It is policy to respect and protect the privacy of our customers and the users of www.execbusinesssolutions.com (hereinafter, the "Site"). Through this Privacy Statement, we want to reassure users of the Site that we will not sell, share, or rent user information to others in a manner different than as set forth in this Internet Privacy Statement.

Application and Information Collection

EBS collects and/or requests information when a user: 1. Submit Application 2. Submits an E-mail We use this information for such purposes as responding to your requests, assessing suitability for services, improving our site, and communicating with you via email, regular mail, or phone. Our Site may also contain links to external Internet sites which may be operated by an external party and they may have privacy practices that differ from those here at www.execbusinesssolutions.com. When you click on links that take you to such external sites, you will be subject to their privacy policies, and we encourage you to become familiar with that party's privacy policies as these may differ from those utilized on our Site. Please note that this privacy statement applies solely to information collected by EBS on our Site and, while we strongly support the protection of privacy on the Internet, we cannot be responsible for the privacy practices of other Websites, uses of the information collected by other Websites, or the content of those other Websites.

Consent

By using our Site, the user agrees to the terms and conditions set forth in this Internet Privacy Statement and the Site Terms of Use INCLUDING ALL LIMITATIONS OF DAMAGES PROVISIONS which are an integral part hereof and the user consents to the collection and use of this information by EBS as disclosed in this Internet Privacy Statement. We may revise this Internet Privacy Statement or the Site Terms of Use at any time by updating these postings. By using this Site you agree to be bound by any such revisions in effect at the time of use and should therefore periodically visit this page to determine the then current policies applicable to users of the Site. If you change your mind and decide you do not wish to receive informational or promotional material in the future, or if you wish to correct or update any contact information you previously provided, please contact info@execbusinesssolutions.com. Or, you may call 404-696-4110 ext 221

How the funds will be used? Do you have a Service Contract or Purchase Order?

With whom do you have a Contract or Purchase Order?

Applicant:

Date:

Attach Resume

Security Code *