Secure Application

bkrisak2018-01-14T05:56:06-05:00

Apply Online

Please fill out the following application in it’s entirety to apply. You should also include the last 3 months of financial information as an attachment.

Comodo Verified Secure Form This form is submitted with a secure encrypted connection, verified by Comodo. If you prefer not sending this information online, you can download our application, complete it in writing, and fax to (860) 509-4224.

Business Information

LEGAL BUSINESS NAME DBA BUSINESS PHONE FAX # COMPANY EMAIL COMPANY WEBSITE
PHYSICAL ADDRESS CITY STATE ZIP
MAILING ADDRESS CITY STATE ZIP
BUSINESS START DATE STATE OF INCORPORATION
FED TAX ID HOURS OF OPERATION
INDUSTRY TYPE Sole Proprietor Partnership Corporation LLC Other
BUSINESS TYPE Retail Wholesale Business Services Customer Services Restaurant or Bar Other
PRODUCTS OR SERVICES SOLD

Member Details

Primary Owner

OWNER NAME TITLE DIRECT OR CELL PHONE # LENGTH OF OWNERSHIP - YEARS: MONTHS: % OF OWNERSHIP HOME ADDRESS CITY STATE ZIP DATE OF BIRTH SOCIAL SECURITY # DRIVER'S LICENSE #

Partner (2nd Owner)

PARTNER NAME TITLE DIRECT OR CELL PHONE # LENGTH OF OWNERSHIP - YEARS: MONTHS: % OF OWNERSHIP HOME ADDRESS CITY STATE ZIP DATE OF BIRTH SOCIAL SECURITY # DRIVER'S LICENSE #

Business Location Details

OWN OR LEASE TIME AT LOCATION - YEARS: MONTHS: RENT AMOUNT (USD) DATE LEASE ENDS PROPERTY MGT OR MORTGAGE COMPANY CONTACT NAME CONTACT PHONE #

Business Trade References

REFERENCE #1 - BUSINESS NAME ACCOUNT # PHONE REFERENCE #2 - BUSINESS NAME ACCOUNT # PHONE REFERENCE #3 - BUSINESS NAME ACCOUNT # PHONE

Additional Financial Details

CURRENT CREDIT CARD PROCESSOR # OF TERMINALS AVERAGE MONTHLY CREDIT CARD SALES (USD) AVERAGE MONTHLY TOTAL SALES (USD) Annual Business Revenue (USD) $Annual Income (USD) $ LOAN AMOUNT REQUESTED (USD) $ REQUESTED DAILY WITHHOLDING % FROM CREDIT CARD RECEIPTS NAME OF ANY PRIOR OR CURRENT CASH ADVANCE COMPANY CURRENT BALANCE (USD) $ DO YOU CLOSE BUSINESS FOR A PORTION OF THE YEAR? Yes No ANY OPEN STATE OR FEDERAL TAX LIENS AGAINST THE BUSINESS OR OWNER(S)? Yes No ANY LAWSUITS OR JUDGEMENTS PENDING AGAINST BUSINESS OR OWNER(S)? Yes No ATTACH PAST 3 MONTHS OF FINANCIAL STATEMENTS Max file size 4MB. These can be faxed to (860) 509-4224 if file-size is too large. Month 1 Month 2 Month 3

Online Signature(s)

PRIMARY APPLICANT NAME AS SIGNATURE APPLICATION DATE By entering my name, I certify that all information in this application and any attached files are accurate. I authorize Family Direct Capital, LLC, its agents, banks, or financial institutions to obtain a personal and business credit report from any credit bureau or a credit agency and authorize Family Direct Capital, LLC to investigate the references given on this and any other statement or data obtained from this application. CO-APPLICANT NAME AS SIGNATURE APPLICATION DATE

Notes & Submit Application

Email Address you prefer all replies go to Any Additional Relevant Notes:

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Funding programs are consistantly changing. Call us to discuss your specific goals. (860) 509-4224

ABOUT US

Family Direct Capital, LLC is a family owned and operated business lending company. Unlike banks, we are not quota based or trying to sell you at higher rates to meet sales goals. We really work for you, and our goal is to find you lending that fits your business' needs while scouting many reputable lenders for the best rates and terms. Your success is our success... Learn More

CONTACT INFORMATION

Family Direct Capital, LLC
500 Four Rod Road
Suite 101A
Berlin, CT 06037

860.509.4224

info@familydirectcapital.com

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