Working Capital Application

Company Name (Complete Legal Name) *

Address *

City *

State *

Zip Code *

Main Phone No *

Fed ID Number *

Years in Business *

Type of Business *

Owner 1: First Name *

Owner 1: Last Name *

Owner 1: Social Security *

Owner 1: % Ownership *

Owner 1: Date of Birth *

Owner 1: Cell Phone No *

Owner 1: Email

Owner 1: Home Address *

Owner 1: City *

Owner 1: State *

Owner 1: Zip Code *

Owner 1: Own/Rent *

Owner 2: First Name

Owner 2: Last Name

Owner 2: Social Security

Owner 2: Home Address

Owner 2: City

Owner 2: State

Owner 2: Zip Code

Owner 2: Date of Birth

Owner 2: Cell Phone

Owner 2: % Ownership

Owner 2: Own/Rent

Owner 2: Email

Gross Annual Sales

Loan Amount Requested

Do you currently have a working capital loan now?

What will you be using the funds for?

Sign Here

Authorization: Applicant warrants that all the information provided Lessor is true and correct, and authorizes Cornerstone Capital and its assignees to investigate applicants credit worthiness as may be needed. The undersigned authorizes all banking institutions, credit reporting agencies, trade references and its agents to release all necessary information via telephone, mail or facsimile as requested, for the purpose of securing a lease, updating, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account.

Signers First and Last Name *

Signing Date *