Online Loan Application - Business Loans Network

Merchant Information

Please complete ALL below information

Legal Business Name *Please enter the legal name of your business

D/B/A NameIf applicable, please enter the D/B/A Name

Physical Street Address *Enter the actual physical location of your business

Suite #If applicable, please enter Suite #

Physical City *

Physical State *

Physical Zip Code *

Business Phone *Please enter your business phone #

Business FaxIf applicable, please enter your business fax #

Email Address *Please enter your email address

WebsiteIf applicable, please enter your website address

Est. Total Monthly Sales *

USD

Enter total monthly sales - Minimum Required $17,000

Est. Monthly Credit Card Sales *

USD

Enter total monthly credit card sales

Years in Business *

EIN # *Please enter your tax id #

Current Business Bank Account *Please enter who you have your business bank account with

Has this bank account been open for at least 90 days? *YesNo

Business Type *Enter the type of business you operate

# of Business Locations *Please enter the # of business locations you currently have

Type of EntityCorporationSole ProprietorshipPartnershipLLC

Is your Business currently for Sale *YesNo

Have you ever filed for Bankruptcy *YesNo

Do you owe any Federal or State Tax Liens *YesNo

Requested Loan Amount *

USD

Please enter your requested loan amount

Intended Use of Money *Please enter use of loan proceeds

First Name

Last Name

Title of Authorized Signer *

Principal Owner Information

Please complete ALL areas

Are you a U.S. CitizenYesNo

% of Ownership *Please enter your % of Ownership

Current Credit ScoreIf known, please enter your EquiFax Credit Score

Principal Owner Name *

Principal Owner Middle Name *

Principal Owner Last Name *

Owner SSN # *Please enter the Principal Owner SSN #

Principal Owner D.O.BPlease enter the Principal Owner Date of Birth

Principal Owner Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Principal Owner Home Phone *

Principal Owner Cell Phone *Please enter your cell phone #

How long at Current Home AddressPlease enter how long you have been living at current address

Do you own or rent your current addressOwnRent

Years at previous Address *How long did you live at previous address

DisclosureI have read and agree with the Disclosure StatementPlease read the following disclosure before submitting this form. By clicking the Submit button you agree you are providing an electronic signature expressly authorizing Alliance Business Capital Inc., and or their assigns, the right to contact you at any telephone number or email address you entered, so we can assist you with your request. This authorization overrides any previous registrations on a federal or state Do Not Call registry or any internal Alliance Business Capital privacy or solicitation preference you have previously expressed.

Proposal Request Form

Please note you have to be in business for 1-month minimum and have revenues of $17K a month or $200K a year for an approval.

Applying For a Business Loan

Online Business Loan Application

Merchant Information

Please complete ALL below information

Principal Owner Information

Please complete ALL areas