Millennium 1st Funding
Please fill in all fields in order for us to expedite your request.
The information you provide will be subject to verification prior to loan funding. All information will be kept strictly confidential.
Amount Requested: $
Purpose of Funds:
Requestor's Name:
Title:
Company Full Legal Name:
Street Address:
City:
State and Zip Code:
AL AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Business Telephone:
Business Fax:
E-mail:
Alternate Phone:
Description of Business/Service:
Briefly describe the purpose of financing:
Personal Guarantees Available:
Yes
No
Credit History of Owner:
Excellent
Satisfactory
Poor
Credit History of Company:
If a Business Purchase, please fill in additional information:
Purchase Price $
Cash Invested by Buyer $
Total Business Assets $
Total Liabilities $
Total Business Net Worth $
Company's Annual Revenue $
Company's Annual Profit $