Northwest Business Finance, LLC FAX INFORMATION TO (509) 465-0162. Call our toll free number: 800 382-5436 or email tony@nwbusinessfinance.com if you have any questions.

PRELIMINARY APPLICATION

(Additional information will be needed to complete a security agreement.)
COMPANY INFORMATION
BUSINESS NAME:
STREET ADDRESS:
CITY:                                                     STATE:              ZIP:                    COUNTY:
TELEPHONE:                                                        FAX:
TYPE OF BUSINESS:
NUMBER OF YEARS IN BUSINESS:                   

LIST SPECIAL LICENSE REQUIRED:

NUMBER OF BUSINESS LOCATIONS:                                 (LIST ADDITIONAL OUTLETS ON REVERSE)
LIST ALL "D.B.A." OR FICTITIOUS TRADE NAMES:

 
CORPORATION [        ]              PARTNERSHIP [        ]            SOLE PROPRIETORSHIP [         ]
WHAT STATE IS THE COMPANY REGISTERED IN?                             COUNTY:
OWNERSHIP INFORMATION
NAME:                                                                   TITLE :
SOC. SEC #                    -                   -
HOME ADDRESS
GENERAL INFORMATION
FEDERAL TAX ID NUMBER:

 
STATE BUSINESS NUMBER:

 
NO. EMPLOYEES:                                

ARE ALL TAXES CURRENT?      YES [        ]        NO[          ]
HOW OFTEN DO YOU PAY 941 PAYROLL TAXES?  

Weekly [        ]      Monthly [        ]       Quarterly [          ]

IF TAXES ARE PAST DUE, DESCRIBE:

 

 
DO YOU CURRENTLY HAVE A TAX LIEN FILED ON YOUR COMPANY?    YES [        ]         NO [         ]
HOW OFTEN DO YOU RECEIVE FINANCIAL STATEMENTS? 

Monthly [     ]   Quarterly [      ]   Semi-Annually [     ]    Annually [     ]

HAVE YOU FIELD YOUR TAX RETURN?   YES [     ]   NO [      ]    LAST YEAR FILED:

HAVE YOU EVER FILED BANKRUPTCY?   YES [     ]   NO [     ]

ARE YOU PRESENTLY INVOLVED AS A DEFENDANT IN ANY LITIGATION?  YES [     ]   NO [      ]

ARE YOU INVOLVED AS A PLAINTIFF IN ANY SUITS?  YES  [     ]   NO [      ]
BANKING INFORMATION
NAME OF BANK:                                                                     YEARS AT BANK:
ADDRESS:                                 

CITY:                                                                                            STATE:

KEY CONTACT PERSON:                                                             PHONE:
ACCOUNT NUMBERS: BRANCH OR LOCATION
CREDIT RELATIONSHIPS: (OPEN OR CLOSED IN THE PAST 24 MONTHS)

TYPE OF CREDIT

AMOUNT OWING

COLLATERAL

CREDITOR
       
       
       
RECEIVABLE INFORMATION
AMOUNT OF INVOICES YOU PLAN TO SELL TO NORTHWEST MONTHLY?   $
AVERAGE MONTHLY SALES:                                      AVERAGE INVOICE SIZE:
TERMS OF SALE:                                                        NUMBER OF CUSTOMERS:

ARE YOU NOW FACTORING? YES [      ]    NO [     ]

ARE YOUR ACCOUNTS RECEIVABLE FREE AND CLEAR?  YES [     ]    NO [     ]

IF NO, WHO HAS A LIEN ON YOUR ACCOUNTS?

SUPPLIER INFORMATION

NAME OF SUPPLIER

WHAT THEY SUPPLY

TERMS

TELEPHONE/CONTACT
       
       
       
OTHER INFORMATION
LANDLORD’S NAME:

ADDRESS: 

PHONE:                                                                                   LEASE EXP. DATE:
ACCOUNTANT’S NAME:

ADDRESS:

PHONE:
ATTORNEY’S NAME:

ADDRESS:

PHONE:
I/WE AUTHORIZE NORTHWEST BUSINESS FINANCE, LLC. TO RELEASE ANY AND ALL INFORMATION IN THIS APPLICATION FOR THE PURPOSE OF COMPLETING A CREDIT INVESTIGATION. THE STATEMENTS MADE ABOVE ARE TRUE AND ACCURATE TO THE BEST OF MY INFORMATION AND BELIEF. I FURTHER UNDERSTAND THAT IF APPROVED FOR FINANCING, THERE WILL BE A $125.00 SET-UP AND APPLICATION FEE WHICH WILL BE DEDUCTED FROM THE FIRST SCHEDULE.
COMPANY:                                                                     BY:

DATE :                                                                        POSITION/TITLE:
IMPORTANT!

INCLUDE THE CURRENT AGING OF ACCOUNTS RECEIVABLE

Checklist of Additional Application Information

        Please Note: Some items may not apply in your situation

( ) Copy of State Business License ( ) Current Accounts Receivable Aging

        If more current than one previously sent with preliminary application

( ) Print out of current customers with telephone number and name of contact person. ( ) Current Accounts Payable Aging ( ) Corporation Papers / Articles of Incorporation ( ) Current Business Financial Statement

        Note: A form can be provided for your convenience

( ) Last 2 Years Business Tax Returns ( ) Current Personal Financial Statement

        Note: A form can be provided for your convenience

( ) Last 2 Years Personal Tax Returns ( ) Copy of Any Current UCC Filings

 
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