Commercial Finance - CommercialFinancing

General Information

Business Name

Email

Website

Street Address

City/State/Zip

Phone

Cell

Federal Tax ID

Type of Business

How did you hear about First Bank & Trust?

Application completed by

Owner & Controlling Entity Information

Principal Owner

Name

Title

% Owned

Street Address

City/State/Zip

Email

Phone

Social Security #

Date of Birth

Please attach a copy of the owner's driver's license.
Current file:

US Citizen
Yes No

Additional Owner Information

Operational Information

Total amount to finance monthly

Has the company or any of the owners ever declared bankruptcy? Yes No

Are there any unsatisfied judgments or liens against the company or its owners? Yes No

Are federal, state, and withholding taxes current? Yes No

Are you doing business under any other name or do you own any other business(es)? Yes No

Has the company ever financed your accounts receivable? Yes No

Is the company currently financing your accounts receivable? Yes No

Does the company currently have a line of credit at a financial institution? Yes No

Does the company currently have a small business loan or merchant cash advance? Yes No

Acknowledgement

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

I affirm that all information provided, including owners and controlling entity, is true and accurate. I authorize First Bank & Trust (as deemed necessary) to verify the accuracy of the statements and information provided and to conduct a credit investigation and background check.

Applicant Signature

Date

The information supplied in and as part of this application is true and correct to the best of my knowledge and belief. I/we hereby authorize First Bank & Trust to investigate the financial responsibility and credit worthiness of applicant, and all principals thereof, identified in this application. I/we grant First Bank & Trust the right to obtain any credit reports pertaining to any party identified in this application. I/we grant First Bank & Trust the right to immediately file any Uniform Commercial Code financing statements securing the applicant’s business assets and naming First Bank & Trust as the Secured Party of applicant. We understand this is an application for commercial financing accommodations only, and any information obtained by First Bank & Trust will be used only for such purposes.

Please attach a copy of a W-9 Form for the business.

Current file: