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*Requires Business Financial Statements

Your Business

Financing Information

Ownership Information

Primary Owner

Percent Owned
0%100%

Ownership Information

Secondary Owner2

Percent Owned2
0%100%

Documentation

Copy of Driver's License
Include Driver's License or Other Photo ID for All Owners
Accounts Receivable Aging Documents
Include A/R Aging Detail and Summary Reports
Accounts Payable Aging Documents
Include A/P Aging Summary Report
Income Statements
Prior Year and Current Year Through Most Recent Month to Date
Balance Sheet Statements
Prior Year and Current Year Through Most Recent Month to Date
Articles of Formation
Articles of Incorporation (Corporation) or of Formation (LLC)
Sample Invoice(s)
Multiple Invoice Samples Preferred
Authorization to Release Information
THE INFORMATION SUPPLIED IN THIS CONFIDENTIAL FINANCING APPLICATION, COMPANY PROFILE FORM, AND ALL FORMS AND DOCUMENTS SUBMITTED (COLLECTIVELY THE "APPLICATION") TO 12FIVE CAPITAL, LLC., ITS SUBSIDIARIES OR ITS ASSIGNEE (COLLECTIVELY "FUNDER") IN CONNECTION HEREWITH IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE AND BELIEF. BY ESIGNING THIS APPLICATION, I/WE HEREBY AUTHORIZE FUNDER TO INVESTIGATE MY/OUR FINANCIAL RESPONSIBILITY AND CREDIT WORTHINESS AND WILL PROVIDE FINANCIAL STATEMENTS, TAX RETURNS, OR OTHER MATERIALS OR INFORMATION AS REQUESTED BY FUNDER AND TO VERIFY ANY INFORMATION PROVIDED FROM ANY SOURCE FUNDER MAY CHOOSE. I/WE GRANT FUNDER THE RIGHT TO PROCURE ANY AND ALL CREDIT OR OTHER INVESTIGATIVE REPORTS TO ANY PARTY TO THIS APPLICATION. I/WE GRANT FUNDER THE RIGHT TO RELEASE ANY OF THE INFORMATION CONTAINED HEREIN OR ANY RESULTS FROM ANY INVESTIGATION OF THE INFORMATION CONTAINED HEREIN TO ANY THIRD PARTY THAT MAY BECOME PART OF ANY FINANCING TRANSACTION BETWEEN APPLICANTS AND FUNDER OR TO WHOM FUNDER MAY REFER THIS APPLICANT TO FOR FUNDING. I/WE FURTHER GRANT TO ANY SOURCE FROM WHICH FUNDER HAS REQUESTED INFORMATION ABOUT APPLICANT(S), THE AUTHORIZATION TO RELEASE SUCH INFORMATION TO FUNDER. APPLICANT ACKNOWLEDGES THAT FUNDER WILL RELY ON THE INFORMATION PROVIDED HEREIN TO MAKE ITS CREDIT DECISION REGARDING APPLICANT. THIS APPLICATION HAS BEEN COMPLETED AND SIGNED OR E-SIGNED UNDER PENALTY OF PERJURY. A PHOTOCOPY, INCLUDING A FAX COPY, OF THIS AUTHORIZATION MAY BE ACCEPTED AS AN ORIGINAL.
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