Business Information Company Name Business Phone Business Fax Business Address Address City State ZIP Amount Requested Federal I.D. No Date of Incorporation Type of Incorporation/Ownership Type of Business Owner 1 Required Fields Full Legal Name* First Name* Middle Initial* Last Name* Title** Ownership%** SSN Number** Phone (Home) Phone (Cell) Date of Birth** Email Address Home Address* Address* City* State* Zip* Owner 2 (If Applicable) Full Legal Name First Name Middle Initial Last Name Title Ownership% SSN Number Phone (Home) Phone (Cell) Date of Birth Email Address Home Address Address City State Zip Financial Needs *Required Fields Describe what your financial needs are. Please be specific. Terms of Financing24 Months36 Months48 Months60 Months10 Years15 Years20 Years Purchase Price Has Any Owner/Officer filed Bankruptcy in the last 5 years?YesNo Do you have collateral that you would like to pledge?YesNo If so, please describe items with estimated value: Financial Documents (If Applicable) Most recent business bank statements - 3 months Most recent business and personal tax returns - 2 years Most recent 1099 (if applicable) Current business profit and loss statement and financial statement Credit report https://www.experian.com/check/credit-scores File 1: File 2: File 3: File 4: File 5: By signing above I/We certify that the information above is true and understand that making false statements might be considered fraud. Applicant named above herby authorizes Quick Wins Consulting and it's affiliates, assigns, agents, banks or financial institution to obtain and view a credit report submitted by applicant. Submitting this application is equivalent to a signature. *If a credit report is provided by a business owner, we are able to eliminate any hard inquiries from financial institutions. Submit Request
