Commercial Credit Application

Requested Credit Facility Amount

$

Requested Initial Advance Amount

$

Requested Facility Type:

Intended Use of Proceeds:

Legal Business Name

DBA Name (if applicable)

Federal Tax ID (EIN)

State of Formation

Date Established

Business Phone

Business Website

Primary Industry

Entity Type:

Business Address

City

State

Zip

Description of Products or Services

Beneficial Owner #1

Full Legal Name

Title

Ownership Percentage

Date of Birth

Home Address

Social Security Number

Email

Phone

Beneficial Owner #2

Full Legal Name

Title

Ownership Percentage

Date of Birth

Home Address

Social Security Number

Email

Phone

(Add additional owners if necessary)

Industry / Primary Services Rendered

Number of Employees

Years in Business

Number of Active Customers

Largest Customer Relationship Duration

% of Revenue from Largest Customer

Gross Revenue (Last 12 Months)

$

Revenue Last 6 Months

$

Average Monthly Revenue

$

Projected Revenue Next 12 Months

$

Current Accounts Receivable Outstanding

$

Average Invoice Amount

$

Largest Invoice Amount

$

Average Payment Terms:

Current Receivables Aging:

Current

$

1-30 Days

$

31-60 Days

$

61-90 Days

$

Over 90 Days

$

Top Five Account Debtors:

Customer	Industry	Outstanding Balance	Avg. Days to Pay

Current Contracts in Progress

To be Invoiced Within 30 Days

$

To be Invoiced Within 60 Days

$

To be Invoiced Within 90 Days

$

Primary Bank

Years Banking Relationship

Business Checking Account Since

Average Monthly Balance

$

Outstanding Business Loans

$

Existing Lines of Credit

$

Existing Factoring Facilities

$

Merchant Cash Advances

$

Outstanding Tax Liabilities

$

Collateral Offered:

Estimated Collateral Value

$

Has the business ever filed bankruptcy?

Yes No

Are there any outstanding tax liens?

Yes No

Are there any pending lawsuits?

Yes No

Are any principals subject to sanctions or governmental restrictions?

Yes No

Is the business currently in default under any financing arrangement?

Yes No

If yes, please explain:

The undersigned certifies that:

The information provided is true and complete.
The financing requested is for commercial purposes only.
CCG may rely upon the information provided.
Submission of this application does not guarantee approval.
Additional underwriting information may be requested.

Applicant Company

Authorized Representative

Title

Date

Signature

CARE CASH GLOBAL (“CCG”)

SECTION 1 — REQUESTED FACILITY

SECTION 2 — BUSINESS INFORMATION

SECTION 3 — OWNERSHIP INFORMATION

Beneficial Owner #1

Beneficial Owner #2

SECTION 4 — BUSINESS OPERATIONS

SECTION 5 — REVENUE INFORMATION

SECTION 6 — ACCOUNTS RECEIVABLE PROFILE

SECTION 7 — CONTRACTS AND PIPELINE

SECTION 8 — BANKING INFORMATION

SECTION 9 — EXISTING DEBT

SECTION 10 — COLLATERAL INFORMATION

SECTION 11 — LEGAL AND COMPLIANCE QUESTIONS

SECTION 12 — REQUIRED DOCUMENTATION CHECKLIST

SECTION 13 — APPLICANT CERTIFICATION