Bright Minds

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Business Business
OWNER OWNER
PROPERTY INFORMATION PROPERTY INFORMATION
CREDIT CARD CREDIT CARD
BANK BANK

Business Detail

Company Name *

Doing Business As

First Name *

Last Name *

Physical Address *

Country

Zip

City

State

Primary Phone *

Cell Phone

Work Phone

Fax

Federal Tax Id *

Date Business Started *

Length of Ownership

Website

Entity Type

Business Type

Product Sold

Use Of Proceeds

Annual Revenue($)

OWNER/OFFICER INFORMATION

Owner First Name

Owner Last Name

Ownership % *

Home Address *

Owner Country

Owner Zip *

Owner City *

Owner State *

SSN *

Date of Birth *

Home #

Cell #

Owner Credit Score

PARTNER INFORMATION (if owner/officer ownership)

Partner First Name

Partner Last Name

Partner Ownership %

Partner Home Address

Partner Country

Partner Zip

Partner City

Partner State

Partner SSN

Partner Date of Birth

Partner Home #

Partner Cell #

Partner Credit Score

BUSINESS PROPERTY INFORMATION

Business Landlord

Contact Name and/or Account #

Business Property Phone #

Business Options

Monthly Rent or Mortgage

CREDIT CARD INFORMATION

Credit Card Processing Terminals

Number of Terminals

Average Monthly Volume

State of Incorporation

Payment Methods

Prior/Current Working Capital / Funding

Balance

BANK INFORMATION

Previous Month Business Deposits

2 Months Ago Business Deposits $

3 Months Ago Business Deposits

4 Months Ago Business Deposits

Previous Month # Neg. Days

2 Months Ago # Neg. Days

3 Months Ago # Neg. Days

4 Months Ago # Neg. Days

Electronic Signature

Add files...

Please drag and drop OR upload the following documents:

3 months bank statements
3 months credit card statements
Drivers License
Voided Check
Lease / mortgage statement

#	title	Type of Document	Created
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