"
*
" indicates required fields
Step
1
of
7
14%
Business Information
Business Legal Name
*
EIN
*
Email
*
Phone
*
DBA (if applicable)
State of Formation
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Date of Formation
*
MM slash DD slash YYYY
For Profit?
*
Yes
No
Business Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Mailing Address (if different)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Organization Information
Type of Organization
*
Sole Proprietorship
Limited Liability Company
Limited Partnership
Limited Liability Partner
General Partnership
Corporation
Joint Venture/Assoc.
Trust
Other
Other Type of Organization
*
Industry
*
Accounting
Construction
Contractor
Education
Engineering
Finance
Food
Health
Legal
Manufacturing
Marketing
Real Estate
Retail Services
Transportation
Wholesale
Other
Other Industry
*
Number of Owners
*
Owners of over 25% will need to fill out the Personal Information sections as well. Please list only those with 25% or more, in descending order.
Please enter a number from
1
to
4
.
Revenue
Last Year’s Annual Revenue
*
Revenue YTD
*
Projected Gross Annual Revenue
*
Amount Requested
*
Please note that the amount requested cannot exceed 10% of projected revenue in order to qualify for preapproval.
Percentage of Project Revenue
This is calculated based on Amount Requested and Projected Gross Annual Revenue
Debt
Do you have any Credit Cards or Lines of Credit on the business?
*
Yes
No
If so, how much?
*
Do you have any other Debt on the business?
*
Yes
No
If so, how much?
*
Owner Personal Information
Percentage of Ownership
*
Please enter a number from
0
to
100
.
Owner Name
*
First
Middle
Last
Email
*
Phone
*
SSN
*
Date of Birth
*
MM slash DD slash YYYY
Position Title
*
Years as Current Business Owner?
*
Please enter a number from
0
to
100
.
Physical Address
*
No P.O. Boxes
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Owner 2 Personal Information
Percentage of Ownership
*
Please enter a number from
0
to
100
.
Name
*
First
Middle
Last
Email
*
Phone
*
SSN
*
Date of Birth
*
MM slash DD slash YYYY
Position Title
*
Years as Current Business Owner?
*
Please enter a number from
0
to
100
.
Physical Address
*
No P.O. Boxes
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Owner 3 Personal Information
Percentage of Ownership
*
Please enter a number from
0
to
100
.
Name
*
First
Middle
Last
Email
*
Phone
*
SSN
*
Date of Birth
*
MM slash DD slash YYYY
Position Title
*
Years as Current Business Owner?
*
Please enter a number from
0
to
100
.
Physical Address
*
No P.O. Boxes
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Owner 4 Personal Information
Percentage of Ownership
*
Please enter a number from
0
to
100
.
Name
*
First
Middle
Last
Email
*
Phone
*
SSN
*
Date of Birth
*
MM slash DD slash YYYY
Position Title
*
Years as Current Business Owner?
*
Please enter a number from
0
to
100
.
Physical Address
*
No P.O. Boxes
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Acknowledgements
Consent to Soft Inquiry
*
You understand that by clicking Submit immediately following this notice, you are providing ‘written instructions’ under the Fair Credit Reporting Act, authorizing Lendrose to obtain information from your personal credit profile and other information from Equifax, TransUnion, and/or Experian to conduct a pre-qualification for credit. This process will not affect my credit score.
I approve a Soft Inquiry for Preapproval
Acknowledge Communication on Electronic Disclosures
*
Communication on Electronic Disclosures
I certify I have read and agree to the Electronic Disclosures communications linked above.
Consent to Hard Inquiry
*
I approve a Hard Inquiry by bank if Preapproved
Consent to Personal Guarantee
*
I acknowledge there may be a Personal Guarantee for Business Loan
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.