Complete Your Business Funding Application

LRD CAPITAL

Business Funding Application

Please complete all sections accurately. Takes about 5–7 minutes.

1. Business Information

Tell us about your business — all fields marked * are required

Legal Name of Merchant *

D/B/A Name (if different)

Business Corporate / Legal Address *

City *

State *

Postal Code

Phone *

Fax

Website

Business Type *

Select type...

Restaurant
Hotel / Motel
Retail
Convenience Store
Bar / Nightclub
Others
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Legal Entity Type *

Select entity..

Corporation
LLC
Partnership
Sole Proprietorship
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Authorized Signer Details

Name of President / Manager / Partner / Owner *

Name of Officer Signing Application *

Title of Signing Officer *

Organization Details

Date of birth *

State of Organization *

Federal Tax ID # *

Number of Employees

Additional Locations (same entity)

Number of Partners / Shareholders

List Partners / Shareholders / Members / Owners

Owner 1

Owner 2

Owner 3

Owner 4

Primary Establishment (if different from above)

Primary Address

Primary Address City

Primary State

Primary phone

Fax

Cell No

How Long Have You Owned Establishment?

Have you filed for bankruptcy *

Yes
No
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Name of Landlord

Landlord Phone

2. Merchant Sales Information

Help us understand your business revenue

Total Annual Credit Card Sales *

Total Annual Sales (Cash + CC)

Number of Seats (if applicable)

Cuisine Type (if applicable)

Is Business Seasonal? *

No
Yes
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% Sales Decrease in Low Months

List Low Volume Months

3. Cash Needs

Minimum $5,000 — Maximum $1,000,000 based on approved credit

Date When Cash Is Needed

Total Cash Needed *

Cash Will Be Used For (select all that apply) *

Inventory

pay taxes

Renovation

Extension

Marketing

Equipment

Cashflow

Pay Off Existing Advance

4.Existing Cash / Financing Providers

List any current cash advances or business loans

Provider 1

Name of cash provider

Current Balance

Amount Funded

Date Funded

Provider 2 (if applicable)

Name of 2nd Cash Provider

Balance

2nd Person Funded

2nd Person Funded date

Pay Them Off?

No

Yes

5. Loan Guarantor Information

Required — must be an authorized signer of the merchant

Full Legal Name *

D.O.B (Date of birth) *

Social Security Number *

State (License) *

Drivers License *

Email *

Cell Phone *

Home address *

Loan guarantor City *

Loan guarantor state *

Home Phone

Own or Rent? *

Personal Bankruptcy? *

Collection Issues Pending? *

6. Signature & Submission

Review authorization and sign to submit

I hereby give permission to LRD CAPITAL (“LRD CAPITAL”), or any agent or credit-reporting agency that it may designate, to obtain any and all information concerning my assets and other credit matters, which they may require in connection with this credit Application. I specifically acknowledge and agree that

(1) all statements which I have made in this Application are made for purposes of obtaining the financing,

(2) verification and reverification of any information which I have supplied in connection with this Application may be made at any time by LRD CAPITAL, either directly or through a credit reporting agency, from any source named in this Application and the original copy of the Application will be retained by LRD CAPITAL, even if the financing is not approved,

(3) LRD CAPITAL will rely on the information which I have supplied herein and I have the continuing obligation to amend and/or supplement that information if any of the material facts which I have represented should change prior to the total obligations under the credit Agreement being paid in full and

(4) each Guarantor, upon request from time to time by LRD CAPITAL, will provide LRD CAPITAL with financial statements and such other information as LRD CAPITAL deems appropriate, all in form and detail satisfactory to LRD CAPITAL.

This Application is part of a credit review process and additional information may be required. LRD CAPITAL may render a credit decision on this application or may elect to submit this Application to one or more banks on the applicant’s behalf and any institution considering this Application shall make its own credit decision regarding this Application. The sales representative submitting this Application cannot extend credit or commit to any financing or funding until a credit decision has been made by the appropriate institution.

Authorized Signer Title *

Signed Date *

Signature *

1. This application must be completed in its entirety. It must be signed and dated by an Authorized Signer of the

Merchant who is also the Loan Guarantor.

2. Along with this application please fax the Merchant’s three most bank statements and the most current

credit card statement.

Preferred Contact Method *

Select...

Business Phone
Cell Phone
Email
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Upload Bank Statements

Please upload your last 3 months business bank statements. This helps us process your application faster. Accepted formats: PDF, JPG, PNG (Max 10MB each).

Bank Statement — Month 1 *

Bank Statement — Month 2 *

Bank Statement — Month 3 *

For Office Use Only — Sales Rep Info
Sales Rep Name: Evens Lauredant
Sales Rep Email: [email protected]
Sales Rep Phone: 646-767-6525
Company Sales Rep Works For: LRD CAPITAL

Company ID Number

Date Submitted