Business Financing Application BUSINESS INFORMATION Legal/Corporate Name DBA Physical Address City State Zip Code Mailing Address (If different from physical address) City State Zip Code Telephone Number Date Business Started State of Incorporation Federal Tax ID Fax Number Email Address Product/Service Sold Type of Entity Sole Proprietor Partnership Corporation LLC Other Franchise Contact Information Have you contemplated filing bankruptcy or have you spoken with an attorney or financial adviser regarding filing bankruptcy in the past 12 months? Yes No Type of Business Retail Wholesale Business Services Consumer Services Restaurant/Bar Other Website Address MERCHANT/OWNER INFORMATION Corporate Officer/Owner Name Title Length of Ownership Years and Months Home Address City State Zip Code Ownership % % Date of Birth Social Security Number Home Phone Number Cell Phone Number PARTNER INFORMATION (Required if less than 51% ownership) Corporate Officer/Owner Name Title Length of Ownership Years and Months Home Address City State Zip Code Ownership % % Date of Birth Social Security Number Home Phone Number Cell Phone Number BUSINESS PROPERTY INFORMATION Own/Lease Own Lease Time at This Location Years Months Monthly Rent or Mortgage $ Date Lease Ends Business Landlord or Mortgage Bank Contact Name and/or Account No. Office/Mobile Number BUSINESS TRADE REFERENCES Business Name Contact or Account Number Phone Number Fax Number Business Name Contact or Account Number Phone Number Fax Number OTHER INFORMATION Current Processing Company Current terminal Type or POS System No. of terminals Average Monthly Credit Card Sales $ Average Monthly Total Sales (Cash, Check and Credit) $ Requested Advance Amount $ Requested Daily Withholding (% of credit card receipts) % Do you usually close the business during part of the year? Yes No Prior/Current Cash Advance Company (if applicable) Current Balance (if applicable) $ Any open State/Federal Tax Liens Against Business or Owner? Yes No Details: Any Lawsuits or Judgments Pending against Business or Owner? Yes No Details: CREDIT CARD PROCESSING Sales Profile (Must Equal 100%) Card Swiped: % + Manually Keyed with Imprint: % + Mail Order/Telephone Order: % + Internet Order: % = 100% Does merchant accept transactions before the customer receives product or services? Yes No % of sales in this category? % How long does customer wait before product is received? % of cost that is prepayment: % Does Merchant offer warranties, dues, subscriptions, memberships or other extended services? Yes No Duration of extended services or benefits: (in weeks) Is the Merchant seasonal: Yes No If yes, please list peak months: January February March April May June July August September October November December to January February March April May June July August September October November December Monthly Visa/MasterCard Volume: Average Ticket: High Ticket: BANK & CREDIT CARD STATEMENTS Please load the last 3 to 4 months bank statements and credit card statements if available (we accept files loaded as PDF or JPEG) By signing below I/We certify the above information is true and correct as set forth in this worksheet. Applicant named above hereby authorize World Global Financing Inc., its affiliates, assigns, agents, bank or financial institutions to obtain an investigative business and/or consumer report from credit agencies and also to investigate the trade references and any other references given on this application and/or on any other documents submitted by applicants. Corporate officer and/or Owner Title Name Date Corporate officer and/or Owner #2 Title Name Date
