Capitable Group

Pre Qualify Form

Businesses

Businesses

Business Financing Pre-Qualification Form

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Business Address *

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[uacf7_step_start uacf7_step_start-65 “Step 2”]
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Funding Request

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Owner / Principal Information

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Personal Information

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Home Address *

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[uacf7_step_start uacf7_step_start-359 “Step 4”]
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Submit my Application

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By signing and submitting this Business Financing Pre-Qualification Form (“Application”) to Capitable Group (“CG”), the undersigned certifies to CG that (i) I am authorized to apply for business financing on behalf of the entity identified above in the Company Information section, (ii) the information provided within this Application is true and accurate, and (iii) I will promptly notify CG of any material changes to such information. This application must be accompanied by additional supporting documents and information as directed by any prospective Lender or Partner (each, a “Lender”) in order to be considered for approval. The undersigned authorizes CG to submit this Application and any other supporting documents and information to each Lender. By submitting this Application, the undersigned authorizes CG and each Lender, and its respective agents, assignees and/or third-party providers to make all inquiries deemed necessary to verify the accuracy of the information provided in this Application (including requesting business and personal credit bureau reports from credit reporting agencies and other sources). Each of the undersigned agrees and understands that CG will retain this Application and all supporting documents and information whether or not this Application is approved.


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Name of person signing this form

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1
[_site_title] “[your-subject]”
[_site_title]
info@capitablegroup.com
From: [your-name] [your-email]
Subject: [your-subject]

Message Body:

Step one : Business Information
Business Name : [BusName]
Business dba : [business-dba]
Business Phone Number : [Busphone]
Website : [Website]

Business Address —
Street Address : [Busaddress1]
Street Address Line 2 : [Busaddress2]
Country : [Buscountry]
State : [Busstate]
City : [Buscity]
Zip Code : [Buszipcode]

Date Business Starter Generating Revenue : [revenue-date]
Legal Entity Type : [legal-structure]
Federal Tax ID : [tax-id]
State of Formation : [formation]
Brief Business Description : [brief-description]
Industry : [industries]
Home Based Business : [home-business]

Step two : Funding Request
Amount Requested : [AmountRequested]
When are funds needed : [funds-need]
Average Monthly Revenue : [monthly-revenue]
Describe the use of funds : [description-funds]

Step three : Owner / Principal Information
Owner Name : [fname]
Last Name : [lname]
Title : [title]
Date of Birth : [dateofbirth]
SSN : [ssn]
Home Address –
Street Address : [Homeaddress1]
Street Address Line 2 : [Homeaddress2]
Country : [Homecountry]
State : [Homestate]
City : [Homecity]
Postal / Zip Code : [Homezipcode]
Where you live : [own-rent]
Email : [email]
Cell Phone :
% Ownership : [ownership]
Number of Business Owners with >20% ownership : [ownership2]

Final step : Authorization
Acceptance : [acceptance]
Signature : [signature-144]
Name : [signaturename]
Date : [date2]


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[_site_title]
[your-email]
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