Advance Business Capital
APPLICATION
Fax (214) 269-8222
COMPANY INFORMATION
Referred By
Business Name
Date Established
 Pick Date
Street Address
MC Number
City State Zip
Federal Tax ID Number
Phone Fax
Type of Business:
Sole Proprietor Corporation LLC Partnership
Email
FMCSA Authority (check all that apply):
Common Contract Brokerage Other
Number of Company Trucks
Number of Owner Operators
Trailer Type (check all that apply):
Dry Van Refrigerated Tanker Other
Factor or finance accounts receivable? Yes No
(If Yes, explain)
Avg. Monthly Sales
$ 		Accounts Receivable
$ 		Avg Invoice Size
$
Pending liens/judgments? Yes No
(If Yes, explain)
Current on all taxes? Yes No
(If No, explain)
Ever file bankruptcy? Yes No
(If Yes, explain)
OWNERS - IMPORTANT INFORMATION
I hereby certify that all information provided on this Application is accurate and complete to the best of my knowledge. I authorize Advance Business Capital LLC ("ABC") to procure credit reports, verifications and other information which, in its sole discretion, is deemed appropriate for completing its credit evaluation, and I provide continuing authorization for any person or business to release such credit reports or verifications to ABC.
Full Legal Name
Position
Ownership Percent
%
Home Address
Email
Date of Birth
 Pick Date 		Social Security Nbr.
City State Zip
Phone - Home
Phone - Cell
Full Legal Name
Position
Ownership Percent
%
Home Address
Email
Date of Birth
 Pick Date 		Social Security Nbr.
City State Zip
Phone - Home
Phone - Cell
Full Legal Name
Position
Ownership Percent
%
Home Address
Email
Date of Birth
 Pick Date 		Social Security Nbr.
City State Zip
Phone - Home
Phone - Cell
>>>> Signature: <<<<
 
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