Financing Application Factor Your Invoices & Improve Cash Flow Today!Banker Agent Application Completing this application is not a guarantee, qualification, obligation or offer by any party to obtain or renders services from Banker Agent or any of our partners.Step 1 of 5 - Company Information0%Company InformationLegal Company or Business Name*Doing Business As (if applicable)Business Description*Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email of Contact Person*All correspondence, including sensitive information, will be sent to this email address. Make sure it is secure. Website EIN*DUNS#*If you do not have a DUNS#, please click here to request one directly from Dun & Bradstreet.Year established*Entity Type*Limited Liability Partnership / CompanyS-CorpC-CorporationSole ProprietorNon-Profit OrganizationCompany Information (Cont'd)Annual Sales*Number of Years Under Current Ownership*Own or Rent Commercial Property?*N/AOwnRentMonthly Mortgage / Rent PaymentServices Sought (choose all that apply)* Select All Invoice Financing (Factoring) Purchase Order Financing Commercial Insurance Commercial Mortgage Commercial Line of Credit Web Design & Marketing ConsultingInvoice Financing Requested Limits*Up to $500k$500k to $1 million$1 million to $2 million$2 million to $3 millionOver $3 millionPurchase Order Financing Requested Limits*Up to $500k$500k to $1 million$1 million to $2 million$2 million to $3 millionOver $3 millionCommercial Insurance Requested Limit*Up to $500k$500k to $1 million$1 million to $2 million$2 million to $3 millionOver $3 millionCommercial Mortgage Requested Amount*Up to $500k$500k to $1 million$1 million to $2 million$2 million to $3 millionOver $3 millionCommercial Line of Credit Requested Limits*Note: The type of credit facility you would be eligible for depends on the financial condition of your company.Up to $500k$500k to $1 million$1 million to $2 million$2 million to $3 millionOver $3 millionList of customers you are looking to finance invoices to and trade history (time and annual volume) with each.List of vendors you are looking to finance invoices from and trade history (time and annual volume) with each.Do you currently have a financing or lending relationship with another institution or individual?*YesNoName of InstitutionName of Officer or Relationship ManagerType of Financing or Loans or Lines of Credit Outstanding Term Loan Growth Capital Line of Credit Asset Based Line of Credit Invoice Financing / Factoring Recourse A/R Purchase Financing Purchase Order FinancingTerm Loan - Amount OutstandingGrowth Capital Loan - Amount OutstandingLine of Credit - Amount OutstandingAsset-Based Line of Credit - Amount OutstandingRecourse A/R Purchase Financing - Amount OutstandingPurchase Order Financing - Amount OutstandingAre any of the company's accounts receivable under lien or used as collateral or security?*YesNoOwnership InformationPERSONAL INFORMATION ON ALL OWNERS, OFFICERS & PARTNERS WHO OWN OR CONTROL 25% OR MORE OF THE COMPANY.Has the company or any of its owners or officers declared bankruptcy in the last five (5) years?*YesNoHow Many Owners?1234Name* First Last Title*SSN*Date of Birth*Ownership %*Please enter a number less than or equal to 100.Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Ownership Information 2Name* First Last Title*SSN*Date of Birth*Ownership %*Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Ownership Information 3Name* First Last Title*SSN*Date of Birth*Ownership %*Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Ownership Information 4Name* First Last Title*SSN*Date of Birth*Ownership %*Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Basic Financial InformationFor each information request below we ask you provide the previous three (3) years of information, if applicable. The more complete, the better we can serve you.Current A/R BalanceCurrent A/P Balance2020 Revenue2020 Net Income2019 Revenue2019 Net Income2018 Revenue2018 Net IncomeAuthorizationAuthorization*I understand that by submitting this online application, I am authorizing the appropriate due diligence be conducted in order to consider me or my company for the services indicated above in this application with Banker Agent and its partners. Due diligence may include hard credit checks on the owners and principals, trade history, invoice and/or purchase order verification and various reports needed for underwriting the appropriate services.I agree to the terms and conditions set forth on this website, including its privacy policy.I acknowledge that completing this application is not a binding offer to extend credit or lend money. Such arrangements will be codified in separate documents.I also authorize Banker Agent to send me a Dropbox link to securely upload supporting documents needed for this application. I agree.*Required DocumentsAfter submitting your online application we will email you a link to a secure Dropbox folder for you to upload the required documents. Depending the services requested, some of the minimum required documents may be: - Annual financial statements - income statements and balance sheets for years ending 2018, 2019, 2020 (the highest level available: audited, reviewed, prepared, or self-prepared). - Monthly financial statements for the last three (3) months. - Prior three (3) years tax returns: 2018, 2019, 2020. - Current accounts receivable aging. - Current accounts payable aging. - Articles of Incorporation / Formation. - Operating Agreement. - Resolutions to Borrow (may be in operating agreement if LLC). - Copies of driver's licenses for each owner and principal or authorized signer.SignatureAuthorized Signature*By signing below you represent that you have the capacity and authority to enter into legal contracts on behalf of the company applying for funding and services and that the information in this application, and provided hereinafter, is true and correct to the best of your knowledge at the time of submittal and can be relied upon as truth and fact. Any falsehoods made will be immediate grounds for terminating your use of the Banker Agent platform and financing programs. Banker Agent reserves all rights to pursue any and all legal actions and remedies the law affords upon and after termination.(Turn screen sideways if needed.)PRINTED SIGNATURE (of above)*CommentsThis field is for validation purposes and should be left unchanged.
