Matrix Business Capital Credit Application

BUSINESS CREDIT APPLICATION PLEASE FAX
OR SEND APPLICATION TO:
401 East Ocean Blvd., Suite 401
Long Beach, CA 90802
Mike Ferguson
Direct: (562) 472-0509
Fax: (562) 206-0283
Email: mike.ferguson@matrixbusinesscapital.com

Matrix Business Capital

LESSEE

Federal Tax ID(*)
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DBA Name (if applicable)
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Business Street Address(*)
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Business City(*)
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Business State(*)
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Business Zip Code(*)
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Type Of Business(*)
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Please Mention if Other(*)
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Number of Employees(*)
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State of Incorporation(*)
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Business Industry(*)
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Years in Business (Current Ownership)(*)
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Primary Contact(*)
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Phone No.(*)
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What is your current bank balance?(*)
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What is your average ending bank balance for the last three months?(*)
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Email Address(*)
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PRINCIPALS (Owners, partners, and principal officers)

First Owner Info

Principals Full Name(*)
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Title(*)
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% Ownership(*)
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Social Security No.(*)
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Home Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Email Address(*)
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Phone No.(*)
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U.S. Citizen(*)
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Date of Birth(*)
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Home Owner(*)
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Second Owner Info

Name
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Title
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% Ownership
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Social Security No.
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Home Address
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City
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State
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Zip Code
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Email Address
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Phone No.
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U.S. Citizen
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Date of Birth
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Home Owner(*)
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Equipment Information

Equipment/Finance Cost $(*)
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Finance Options(*)
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Ship To Address(*)
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Desired Address
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Equipment Condition(*)
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Equipment Location(*)
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Desired Address
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Equipment Description... (*)
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Credit Questionnaire

Please complete the following questions to the best of your ability. This information enables our credit and finance department to establish the best financing terms available for your company. Applications submitted without this questionnaire will not be accepted. Please circle and fill in the blanks applicable below.

1. If needed, are company financials/personals and tax returns available?(*)
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a. If yes, did you earn a profit last year?
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2. Do any of the principal owners have any past due bills that have unpaid balances?(*)
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a. If yes, how much is the total outstanding amount? $
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b. If yes, are they able to pay the outstanding amount?
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3. Have any of the principal owners ever had a bankruptcy?(*)
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a. If yes, what year?
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b. If yes, has it been discharged?
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c. If yes, was it business, personal or both?
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4. Do any of the principal owners have any open tax liens or judgments?(*)
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a. If yes, what is the outstanding amount owed? $
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b. If yes, are they able to pay the amount owed?
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c. If yes, was it business, personal or both?
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5. Have any of the principal owners ever had a foreclosure, short sale, or loan modification?(*)
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a. If yes, what year?
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b. If yes, what was the total amount? $
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c. If yes, has it been closed?
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6. Do any of the principal owners have a criminal record?
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a. If yes, what year did this occur?(*)
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b. If yes, was it a felony or misdemeanor?
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c. If yes, please explain?
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7. Is your company currently working with any other finance companies?(*)
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a. If yes, what companies have you worked with in the past 12 months? (List below)
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b. If yes, have you funded any leases in the past 12 months?
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c. If yes, what is the total dollar amount funded in past 12 months? $
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