No-Obligation Loan / Lease Application

Rock Capital & Associate will use this information to identify potential lenders.  The information you provide will be subject to verification prior to loan funding.  All information provided by you will be kept strictly confidential and be delivered in a secure method to a lender.

 

PRINCIPAL'S NAME:
Title: 
Company name:
Street Address: 
City / Town:
State / Province:
Zip / Postal Code: 
Telephone Number: 
Cellular Phone: 
Fax:
Email:
  Start-up  

 Existing Business 
Years in Business: 

  Sole Proprietorship 
Partnership 
Corporation 
Industry: 
Amount of Financing Requested: 
   
Purpose of Financing: Franchise Purpose  Equipment Financing  Start-up Financing 
  Working Capital  Receivables Financing  Factoring  
  Other (Please Specify): 

   
Briefly Describe the purpose of Financing:

Personal Guarantees Available: 
  Yes        No 

Credit History of Owner:		 Excellent   Satisfactory  Poor 

Credit History of Company:		 Excellent  Satisfactory  Poor 

If a Business Purchase: 		 Purchase Price  $
  Cash Invested by Buyer $
  Total Business Assets  $
  Total Liabilities  $
  Total Business Net Worth  $
  Company's Annual Revenue  $
  Company's Annual Profit  $
   
How did you hear about this email application? 
 
 
 

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