General Information

Business Legal Name

Doing Business As

Federal Tax ID

Business Start Date

Business Phone

Business Fax (Optional)

Business Website

Credit Score

NAICS Code (Optional)

Business Social Media Site (Optional)

Physical Address

Mailing Address

Business Information

Business Description

Renter or Owned Please Select Renter Owned

Rent/Mortgage Amount

Landlord/Mortgage Company Contact

Open Bankruptcy? Please Select Yes No

Any Open Judgments? Please Select Yes No

Any Tax Liens? Please Select Yes No

Do you currently have any loans? If yes, what kinds and what is the balance?

Explain changes in Sales/Profit, or Debt (+/–10%)

How much Capital is being requested?

Repayment Terms Please Select Daily Weekly Monthly

Credit Card Montly volume

Total Monthly Sales (All Forms of Revenue)

Gross Annual Sales (Last year's Tax Return)

Number of Customers

What are your business growth plans for the next 3 to 5 years?

Broker? (Who referred you to us?)

By signing below, the Merchant and its owners/principals:

(1) I certify that all information and documents submitted in connection with this application are is (are) true, correct and complete.

(2) I authorize LNSGROUP LLC, its agents, and lenders to obtain & receive credit reports and other information regarding the Merchant and its owners and principals from third parties, to verify any information provided on this application.

(3) I authorize LNS Group LLC to obtain such information solely to prequalify me for credit options in connection with evaluating my eligibility for working capital and related financing solutions. Print Name

Date

Please upload:

• 3 current months Bank statements (all pages)
• Drivers License
• EIN Letter
• Corporate Formation Documents

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Note: All fields Are Required on this Application before Submission.

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