Name: * Title:
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Street Name: Town:
Address 2: County:
Address 3: Postcode:
Mobile Phone:
Fax:
Age of Business:   Start-up                      Existing Business         
Years in Business:
Type of Business: Sole Proprietorship Partnership             Corporation

Industry:
Amount of Financing Requested:
Purpose of Financing:
Franchise Purchase Equipment Financing Start-up Financing
Working Capital Receivable Financing Factoring
Property Finance
Other:
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Personal Guarantee Available:   Yes No
Credit History of Owner:              Excellent Satisfactory Poor
Credit History of Company:        Excellent Satisfactory Poor

If Business is a Purchase: Purchase Price
Cash Invested by Buyer
Total Business Assets
Total Business Liabilities
Total Business Net Worth
Companies Annual Revenue
Companies Annual Net Profit
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