Unique Solution Online Financing Application

Business Information:
Business Name:
     
   
Street Address:
City:
 State:
Zip Code:
 
Mailing Address: (if different)
City:
 State:
Zip Code:
 
Phone:
Fax:
  
Years in Business :
    
Industry:
Web:
        
Contact Information:
Contact Person:
   
Phone:
 How did you hear about us?  
Email:
 Where is best to contact you?
Additional Information:
Describe the nature of your situation and what type of financing proposal you seek :
 
Describe the business uses of your fund
(Marketing expansion, acquiring inventory, etc.) :
 
What is the total loan amount requested?
$
 
Describe any collateral that could be used
(Property, Inventory, Receivables, Notes, etc :
 
Estimated Dollar amount of collateral that can be pledged?
$
 
By what date do you need to secure financing?
   
 
Have you already sought out other help in obtaining this financing?

Yes
 
Gross Revenue (current or projected for a new business):
$
Expenses before taxes (current or projected for a new business):
$
 
Does your business have other outstanding financing?

Yes
 
Total Amount of Outstanding Financing (Include Principle Only)
$
 
Total Monthly Payments (Principle & Interest):
$