Application
1.    Business Name (as shown on the Articles of Incorporation)_______________________________________________...
19. Main Contact      Name________________________________________________________________ Soc. Sec # ____________________...
TAX INFORMATION

33.                                   -
      Federal Tax ID#______________ _____________________________...
GENERAL INFORMATION

43.   Are there any judgments or lawsuits pending or outstanding against your company?          Yes _...
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ABL Financing Application

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ABL Financing Application

  1. 1. Application 1. Business Name (as shown on the Articles of Incorporation)___________________________________________________________________________ 2. Type of Legal Entity: Corporation ___ LLC ___ Partnership ___Proprietorship ___ Sub-S Corporation ___Other ________________ (Please Specify) 3. Years in Business _____________ Date Incorporated _______________ State Incorporated ________________________________________________ 4. Street Address of Headquarters_____________________________________________________________ County______________________________ 5. City, State, Zip__________________________________________________________________ Phone (________)_____________________________ 6. Type of Business________________________________________________________________ Fax (________)_______________________________ 7. Website Address ____________________________________________________________________________________________________________ 8. If doing business in more than one place, attach list of all other locations (full mailing address & county) Not Applicable ________ Attached _________ 9. List Trade Names, DBAs; Assumed Names & Fictitious Names________________________________________________________________________ 10. Attach list of ALL Subsidiaries, Affiliates, Joint Ventures, Partnerships, etc. and indicate relationship and ownership. Attached ________ None ________ 11. Has company ever done business under any other names not listed above? Yes __________ No __________ If Yes, attach list of names 12. Length of Current Ownership ______; If less than 2 years explain ______________________________________________________________________ 13. Does the Company own any Real Estate? Yes _______________ No ______________ If Yes, attach list of addresses. 14. Number of Employees: ____________________ Annual Sales: __________________________ PRINCIPALS AND OFFICERS Please list all corporate officers and all ownership interests of 5% or more (attach additional sheet if necessary): 15. President/CEO Name________________________________________________________________ Soc. Sec # _____________________________ % Stock Owned_____ Home Street Address_________________________________________________________ Own ____________ Rent____________ City, State, Zip________________________________________________________________County___________________________ Date of Birth______________ Drivers’s License Number (include copy with application) __________________________________ Home Phone: (____)___________ Work Phone(____)_________ Cell Phone (_____)_________ E-mail address__________________ 16. Secretary Name________________________________________________________________ Soc. Sec # _____________________________ % Stock Owned_____ Home Street Address_________________________________________________________ Own ____________ Rent____________ City, State, Zip________________________________________________________________County___________________________ Date of Birth______________ Drivers’s License Number (include copy with application) __________________________________ Home Phone: (____)___________ Work Phone(____)_________ Cell Phone (_____)_________ E-mail address__________________ 17. Treasurer/CFO Name________________________________________________________________ Soc. Sec # _____________________________ % Stock Owned_____ Home Street Address_________________________________________________________ Own ____________ Rent____________ City, State, Zip________________________________________________________________County___________________________ Date of Birth______________ Drivers’s License Number (include copy with application) __________________________________ Home Phone: (____)___________ Work Phone(____)_________ Cell Phone (_____)_________ E-mail address__________________ 18. Other Owner Name________________________________________________________________ Soc. Sec # _____________________________ % Stock Owned_____ Home Street Address_________________________________________________________ Own ____________ Rent____________ City, State, Zip________________________________________________________________County___________________________ Date of Birth______________ Drivers’s License Number (include copy with application) __________________________________ Home Phone: (____)___________ Work Phone(____)_________ Cell Phone (_____)_________ E-mail address__________________ 1
  2. 2. 19. Main Contact Name________________________________________________________________ Soc. Sec # _____________________________ % Stock Owned_____ Home Street Address_________________________________________________________ Own ____________ Rent____________ City, State, Zip________________________________________________________________County___________________________ Date of Birth______________ Drivers’s License Number (include copy with application) __________________________________ Home Phone: (____)___________ Work Phone(____)_________ Cell Phone (_____)_________ E-mail address__________________ COMPANY LOCATION INFORMATION 20. Are you presently leasing your company headquarters? Yes___________ No__________ If yes, what is the monthly rent?____________________ 21. Name of Landlord/Management Co. _____________________________________________________________________________________________ 22. Street Address ______________________________________________________________________________________________________________ 23. City ___________________________________________________________ State______________________ Zip Code ______________________ 24. Phone Number (______) ______________________________________________________________________________________________________ 25. Period of Lease ______________________________________________________ Monthly Rent __________________________________________ 26. If you have inventory, is it all located here? Yes___ No ___; If No, Please Explain________________________________________________________ 27. Any Hazardous materials stored on company property? Yes ___ No___; If Yes, Please Explain______________________________________________ PROFESSIONAL REFERENCES 28. Name of Accountant____________________________________________________________ Firm_________________________________________ Street Address______________________________________________________________________________________________________________ City _______________________________________________________ State ____________________________________ Zip Code _____________ Phone Number (___) ______________ Fax Number (___) _____________ E-Mail Address ______________________________________________ 29. Name of Attorney_____________________________________________________________ Firm___________________________________________ Street Address______________________________________________________________________________________________________________ City _______________________________________________________ State ____________________________________ Zip Code _____________ Phone Number (___) ______________ Fax Number (___) _____________ E-Mail Address ______________________________________________ 30. Name of Insurance Agent______________________________________________________ Firm___________________________________________ Street Address______________________________________________________________________________________________________________ City _______________________________________________________ State ____________________________________ Zip Code _____________ Phone Number (___) ______________ Fax Number (___) _____________ E-Mail Address ______________________________________________ 31. Name of Registered Agent (recommend replacing with Other Business Reference #1)__________________________________________________ Street Address______________________________________________________________________________________________________________ City _______________________________________________________ State ____________________________________ Zip Code _____________ Phone Number (___) ______________ Fax Number (___) _____________ E-Mail Address ______________________________________________ 32. Other Business Reference #2______________________________________________ Relationship to Company_______________________________ Street Address______________________________________________________________________________________________________________ City _______________________________________________________ State ____________________________________ Zip Code _____________ Phone Number (___) ______________ Fax Number (___) _____________ E-Mail Address ______________________________________________ 2
  3. 3. TAX INFORMATION 33. - Federal Tax ID#______________ ________________________________________________ 34. Fiscal Year End Date __________________________________ Date of Last Income Tax Return Filed _______________________________________ 35. How often are Form 941 payroll taxes filed/paid?________ Do you prepare the payroll taxes? ____________ If not, who does?___________________ 36. Are any Federal, State, County or Local taxes past due or any tax liens outstanding, or have you received notice of intent to file tax liens? Yes__; No ___ If yes regarding past due taxes, how much $____________ and in what jurisdiction (state/federal etc.)? __________________ 37. IRS Contact _____________________________________________________________ Phone Number (_____) ____________________________ BANKING & CREDIT INFORMATION 38. COMPANY CHECKING ACCOUNT Name of Bank ______________________________________________________________________________________________________________ Street Address ______________________________________________________________________________________________________________ City ____________________________________________________________ State _________________________________ Zip _______________ Account Number _______________________________ Bank Officer ________________________________________________________________ Phone Number (_____) _________________________ Date Opened _______________________________________________________________ 39. COMPANY LOAN ACCOUNT and COMMERCIAL LINES OF CREDIT Name of Financial Institution ___________________________________________________________________________________________________ Street Address _________________________________________________ City _________________________ State ______ Zip _________________ Account Number ___________________________________ Date Opened:___________________________ Bank Officer __________________________________ Phone Number (_____) ________________________ Maximum Balance $______________________________ Present Balance $____________________________ Collateral Supporting Loan(s) ___________________________________________________________________________________________________ If additional accounts/lines of credit, please attach a schedule EQUIPMENT LOANS/LEASES 40. Name of Financial Institution or Leasing Company______________________________________ Loan Officer ________________________________ Street Address ______________________________________________________________________________________________________________ City ____________________________________________________________ State _________________________________ Zip ________________ Phone Number (_____) _____________________ Date Opened _______________________ Term _______________________________________ Original Loan Amount ________________________ Monthly Payments ________________________ Present Balance ________________________ If additional equipment loans/leases, please attach a schedule. REAL ESTATE LOANS 41. Name of Financial Institution or Mortgage Company ____________________________________ Loan Officer ________________________________ Street Address ______________________________________________________________________________________________________________ City ____________________________________________________________ State _________________________________ Zip ________________ Phone Number (_____) _________________________ Date Opened ________________________________ Term __________________________ Original Loan Amount ________________________ Monthly Payments __________________________ Present Balance ______________________ Balloon? ________________________ If so, When? ____________________________________ Collateral: __________________________________ If additional real estate loans, please attach a schedule. PERSONAL ACCOUNT OF ______________________________________________________________________, Title _____________________________ 42. Name of Bank _______________________________________________________________________________ Date Opened __________________ Street Address ______________________________________________________________________________________________________________ City ____________________________________________________________ State _________________________________ Zip ________________ Account Number _________________________________________________________ Phone Number (_____) ______________________________ 3
  4. 4. GENERAL INFORMATION 43. Are there any judgments or lawsuits pending or outstanding against your company? Yes _______________ No _______________ 44. If Yes, describe ____________________________________________________________________________________________________________ 45. Have any of your company's corporate officers ever been convicted of any criminal offense other than a minor motor vehicle violation? Yes __________ No __________ 46. If Yes, describe ____________________________________________________________________________________________________________ 47. How often are Financial Statements prepared? ______________________________________By whom? ____________________________________ 48. Has the company ever filed Bankruptcy? Yes _____ No _____ If Yes, in what year? ____________________________________________________ 49. Have any of the owners declared Bankruptcy? Yes ____ No ____ If Yes, who and in what year? ___________________________________________ 50. Date Property Insurance is paid through ________________________________________________________________________________________ 51. Do you offer a warranty or guaranty with, or permit returns of, your goods or services? Yes _________________ No __________________ 52. If Yes, explain _______________________________________________________________________________________________________________ The undersigned hereby certifies that the above information is correct and complete. As a part of the application, the undersigned hereby grants to SPECTRUM Commercial Services Company its consent and authorization to contact consumer and commercial credit reporting agencies as well as the people and organizations listed above, and any other references disclosed by such agencies, people or organizations. The undersigned also represents and acknowledges that the individuals listed above under "Principals and Officers" have, as individuals, granted their consent to SPECTRUM Commercial Services Company to contact consumer and commercial credit reporting agencies and any other references disclosed by such agencies. Please commence your due diligence work for the purpose of deciding whether to offer the financing requested by us. Please note that, in addition to any application or survey fee that may have been paid by us, we will reimburse you for your out-of-pocket costs including, but not limited to, UCC, tax lien, and judgment search fees and appraisal costs. We acknowledge that SPECTRUM Commercial Services Company has not agreed to provide financing, and shall at no time be considered to have offered or committed to any financing, loan or credit facility except in an explicit writing, dated subsequent to this application, and signed by you. Any fees paid by us are for survey and investigation only. _________________________________________________________ Date Signed:_____________________________________ [Print Company Name] ____________________________________________________________________ [Signature of Authorized Representative] ____________________________________________________________________ [Print Name and Title of person signing] 4

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