Client Financing Application Jimmy

BUSINESS INFORMATION:

Corporate/Business Name:(Required)

DBA:(Required)

Company Website:(Required)

Date Company Established:(Required)

Address :(Required)

Phone #:(Required)

Company Email :(Required)

PRINCIPAL/OWNERS/OFFICERS :

Name(Required)

Email(Required)

Address :(Required)

% Business Ownership :(Required)

Job Title:(Required)

Cell Phone :(Required)

Date Of Birth :(Required)

What is your FICO score?(Required)

OFFICE PROFILE :

Average Requested Amount : $(Required)

How many clients request financing per week?(Required)

Brief description of the services/products you provide :(Required)

ADDITIONAL INFORMATION:

Signature Officer/Owner/Partner(Required)

Title(Required)

Signature Officer/Owner/Partner

Title

Date Signed

Client Financing and it's Partner's (Partner) is authorized to investigate my (our) credit reports, police records and any other public or private information supplier of data. Partner may verify any and all information given throughout this application or within any other documents provided to Partner. With reference to Partner's investigation, should any person, company or agency request specific written authorization to release requested information, photo copies or facsimiles of my (our) signatures below may be utilized to show my (our) acknowledgment and authorization to release requested information. I (we) hereby certify that all of the statements made throughout this application are true and correct.

I authorize ClientFinancing and partners to verify or obtain further information as it may deem necessary concerning the entity and its Partners and Owners, including the use of credit reporting agencies.

Client Financing Application Jimmy

Merchant Enrollment Application