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Home
Real Estate Investments
Zero Percent Financing
Business Funding
Apply Now
Affiliates
Resources
FAQ
Areas We Serve
Contact

(888) 927-6177

BUSINESS INTAKE FORM

BUSINESS FUNDING INTAKE FORM

Affiliate Name:

Client First Name:

Client Last Name:

Email:

Phone Number:

Legal Entity Name (If Applicable):

Entity:

Entity Ownership:

State Of Incorporation:

Year Of Incorporation:

Time In Business:

Industry:

Annual Sales:

Avg Monthly Revenue:

Requested Funding Amount:

Usage of Funds:

How Soon Needed:

Borrower FICO Score:

Bankruptcies, Liens or Repossessions :

Any Charge Offs/Late Payments Last 2 Years:

Any Loans Taken Out Within Past 2 Years:

Is your credit profile locked?

Are you working with any other brokers?

Any Additional Info:

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Business Funding Application | Access Capital Lending Group

Business Funding Application

ACLG BUSINESS INTAKE FORM

Access Capital Lending Group

accesscapitallendinggroup.com

Business Funding Application

APPLICANT INFORMATION

First Name *

Last Name *

Email *

Phone Number *

I Consent to Receive SMS Notifications and Alerts from Access Capital Lending Group LLC. Message frequency varies. Message & data rates may apply. Text HELP to (888) 927-6177 for assistance. You can reply STOP to unsubscribe at any time. By checking this box I agree to receive occasional marketing messages from Access Capital Lending Group LLC. Message frequency varies. Message & data rates may apply. Text HELP to (888) 927-6177 for assistance. You can reply STOP to unsubscribe at any time.

Terms and Conditions | Privacy Policy available at accesscapitallendinggroup.com

BUSINESS ENTITY DETAILS

Legal Entity Name (If Applicable)

Doing Business As (DBA)

Entity Type

Entity Ownership

State of Incorporation

Year of Incorporation

Business Start Date (MM/DD/YYYY)

FEIN (Tax ID)

BUSINESS ADDRESS & CONTACT

Business Address

City

State

Zip

Business Phone

Website

BUSINESS PROFILE

Time in Business

Industry

Annual Sales

Average Monthly Revenue

Do You Own Real Estate?

Yes No

Are Your Customers Businesses or Consumers?

Do You Have Accounts Receivable (AR)?

Yes No

How Much AR Do You Have?

FUNDING REQUEST

Requested Funding Amount *

Usage of Funds

How Soon Needed

CREDIT PROFILE

Borrower FICO Score

Bankruptcies, Liens, or Repossessions

Yes No

Charge Offs/Late Payments (Last 2 Yrs)

Yes No

Any Loans Taken Out Within Past 2 Years?

Yes No

Is Your Credit Profile Locked?

Yes No

Are You Working With Any Other Brokers?

Yes No

OWNER / PRINCIPAL INFORMATION

Date of Birth (MM/DD/YYYY)

% of Ownership

Home Address

Home City

Home State

Home Zip

SSN

ADDITIONAL INFORMATION

Any Additional Info

How Did You Hear About Us?

CONSENT & AUTHORIZATION

I consent to receive the customer care and account notification-related SMS messages from Access Capital Lending Group to arrange my appointment and respond to my inquiry. I acknowledge that message frequency will vary and that msg&data fees may apply. Reply STOP to stop, Reply HELP for help. View our Privacy Policy for more information. * I AGREE to the Terms above and certify that I have read and agreed to the Consent to Electronic Disclosures provided. * I AGREE: By checking this box, you are providing written instructions to Access Capital Lending Group under the Fair Credit Reporting Act, authorizing Access Capital Lending Group to obtain information from your personal credit profile or other information from Experian. You authorize Access Capital Lending Group to obtain this information solely to conduct a credit pre-qualification. You also authorize Access Capital Lending Group to share your application status and related information with the individual or business that referred you. Our proprietary software uses a 'soft' credit pull to match your credit history with loan criteria, providing a reliable pre-qualification without impacting your credit. Additionally, pre-qualifying consumers may receive special loan offers tailored just for them.

CERTIFICATION & SIGNATURE

By signing below, you certify that all information provided in this Application, including any supporting documents, is true and complete, and you agree to notify Access Capital Lending Group promptly of any adverse or material changes to information previously supplied. You understand and agree that Access Capital Lending Group and its agents and assignees are authorized to contact third parties to make inquiries, and to request business and personal credit reports, for any update, renewal, or other lawful purpose related to this Application.

Signature (type full legal name to sign electronically) *

Print Name *

Date (MM/DD/YYYY) *

326 Penn Ave

West Reading, PA 19611

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