INDUSTRIAL ASSETS CAPITAL APPLICATION. BUSINESS INFORMATION Brief description of business: - Legal Business Name: Federal ID #:

Transcription

1 INDUSTRIAL ASSETS CAPITAL APPLICATION Industrial Assets Capital Ventura Blvd. Floor 2 Studio City, CA BUSINESS INFORMATION Brief description of business: - Legal Business Name: Federal ID #: Entity Type: Corporation LLC Sole Proprietorship Partnership Other Date Established Trade Name/D.B.A: City, State/Province, Zip: County: Website: Address: Telephone: Fax: Cell: Does the company own real property? If yes, address of the owned real property: Overall Sq. Ft.: If company does NOT own real property, does a related entity own real property? If yes, please provide names of related entity and corresponding real property address: Page 1 of 5

2 OWNERSHIP INFORMATION Owner s Full Name: Date of Birth: Home Address: Own Rent Home Telephone Cell Number: SSN: Ownership Percentage: % Title: Address: Additional Owner: Full Name: Date of Birth: Home Address: Own Rent Home Telephone Cell Number: SSN: Ownership Percentage: % Title: Address: Do any of the owners have a Trust? TRUST INFORMATION If yes, please provide the name (s) of Trust (s) below and provide a copy of each trust BUSINESS PROFESSIONALS INFORMATION Accountant s Name: Firm: City: State: Zip: Page 2 of 5

3 Phone: Fax Attorney s Name: Firm: City: State: Zip: Phone: Fax TAX INFORMATION Number of employees: How often do you file 941 Payroll Taxes? Weekly Monthly Quarterly Yearly Are Payroll Taxes current? Are there any outstanding Personal Property or Real Property taxes? If yes, how much? Do you have any Federal or State Taxes past due? If yes, has lien been filed? If yes, list type, quarter/year and amounts below: Type: Quarter: Year: Amount BANKING INFORMATION Business Checking Account Bank Name: Address: City: State: Zip: Account Numbers: Bank Officer s Name: Phone: Business Loan Account Name of Financial Institution: Page 3 of 5

4 How long with institution? Loan Amount: Phone: Collateral: Personal Account of: President Proprietor Partner Bank Name: Date Account Opened: Address: City: State: Zip: Checking Account No.: Phone: What is the purpose of the funds you are requesting? MACHINERY & EQUIPMENT COLLATERAL INFORMATION Is there a formal appraisal existing that provides the total liquidation value for the machinery and equipment? If yes, please attach a copy of the appraisal. If no formal appraisal exists, please provide an accurate machinery and equipment listing. Are receivables pledged as collateral? If yes, to whom? Is inventory currently pledged as collateral? If yes, to whom? Are there any commercial loans/leases outstanding? If yes, list here: Has the machinery and equipment been operated in any other physical location? If yes, list all below: Page 4 of 5

5 Why do you need financing? Are you currently in default? Are you in a restructuring? Please list any lawsuits or tax liens: Who is providing your current financing on the machinery and equipment? What is the amount currently owned on the machinery and equipment? Who is providing your current Line of Credit? What is the amount of this Line of Credit? What is the current outstanding amount on this Line of Credit? As of: How did you hear about Industrial Assets? The information supplied in this Application for Funding and all forms, financial statements and documents submitted in connection herewith are true and correct to the best of my knowledge and belief. The undersigned individual who is either a principal of the credit applicant or the sole proprietor of the credit applicant recognizing that his/her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report, from time to time as may be needed, for credit evaluation purposes. The undersigned without further notice hereby authorizes Industrial Assets Capital, and/or its designates or assignees to obtain a consumer credit report and to make whatever inquiries deemed necessary concerning the parties herein for credit evaluation purposes no or at any time in the future. By: Date: Print Name: Print Title: By: Date: Print Name: Print Title: Return this form by fax or tali@industrialassets.com with a copy of your Certificate of Incorporation Page 5 of 5