Business Funding Solutions | Access Capital Lending Group LLC

Affiliate Name:

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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:

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BUSINESS INTAKE FORM