NOVA BUSINESS LENDERS NOVAHELAINE@GMAIL.COM 646-745-7293

LOAN APPLICATION FORM

GENERAL BUSINESS INFORMATION

Legal Company name: DBA:

Work Phone: Fax: E-mail:

CompanyPhysical Address:

City: State: ZIP Code:

Business Start Date: Percentage Ownership:

State ofIncorporation:

PartnershipCorp/ LLC: Website:

Company Type/Industry: Tax ID: (Nine Digits) __-_______

Annual Business Revenue: Monthly Credit Card Vol:

Do you Own or Rent business property: Mortgage/ Rent Cost:

Landlord Name/ Phone/ Email:(if applies)*BUSINESS BANK STATEMENTS NEEDED: PLEASE ATTACH LAST 6 MONTHS BUSINESS BANK STATEMENTS (and also last 6 month credit card statements; if applies)

BASIC LOAN INFORMATION

Loan Purpose:

Loan Amount Requested:(Up to $1,500,000)

Loan Term Requested:(3,6,9,12,18, 24, 36 months)

Any Current Bank Loans Out (From Whom/ Existing Balances):

Are Taxes Current/ Any Existing Tax Liens or Bankruptcy: YES/ NO (explain, if yes):

FICO Score:

By signing and faxing or e-mailing us your Loan Application, you certify that (i) you are authorized to apply on behalf of the company whose full legal name appears above under the Company Information portion of the Loan Application for a business loan from us and (ii) all information you provide within the Loan Application and other supporting documents is true and complete and that you will notify us of material changes to such information. You understand and agree that we and our agents and assignees are authorized to contact third parties to make inquiries in evaluating your Loan Application (including requesting personal credit bureau reports from credit reporting agencies and other sources) or for any update, renewal, extension of credit or other lawful purpose. Upon your request, we will advise you if we obtained a credit report and will give you the credit bureau’s name and address. You understand and agree that we may provide credit and other information from the Loan Application and on the signing individual(s) and the company with third parties who may use the information for any lawful purpose, including for the purpose of offering credit and/or other products and services to the signing individual(s) and/or the company.

SIGNATURE

DISCLOSURE

BUSINESS OWNER IDENTITY

Full Legal Name:

Home Address(physical address):

City: State:ZIPCode:

HomePhone:

CellPhone: E-mail:

Own or Rent Home: Are all payments current: YES/ NO(landlord name/ #, if rent) (explain, if no)Do you own other properties:(explain)

Do you have other assets:(explain)

Social Security #: Date of Birth:

Driver’s License #/ State:Other Sources of Income/Approx total income:

Partner info (if any)-Name/ Address:

Partner- Phone/ Email

Name: ______

Signature: ___

Date: _______ _