* = Required Information

Contact Information

First Name: * Last Name: *

Home Address: Zip:

City: State:

Phone Number: * Home Cell Work Office

Annual Income (only put the last four digits:) Email Address: *

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

Credit Score

Dunn: Equifax Experian

Business Credit USA:

Company Phone Number: Is number listed? Yes No

Do you have any business accounts not reported on the credit file? Do any of the companies have a Dunn’s number?

Do you have a 9-digit D-U-N-S Number? Yes No D-U-N-#

Do you have a Federal Tax Id Number? Yes No FEIN #

Are you certified to meet government contract requirements? Yes No

Are you seeking to increase revenue? Yes No

Are you SBA Registered? Yes No

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 perform corporate credit building & structure services. . 2.If currently in business a copy of the businesses credit report will be required from all bureaus. If seeking a loan, How much and How will the funds will be used? 3. Applicant agrees not to make any applications while in the program. 4. EBS is a consulting firm that refers business owners and clients to business loan brokers. EBS is not a lender. We encourage Applicants to educate yourself on the funding guidelines prior to accepting any loans.

Applicant:

Date:

Security Code *