SHORT FORM MERCHANT APPLICATION & AUTHORIZATION TO REVIEW CREDIT

Merchant Information (Please Complete ALL Information Below Accurately)

Legal Business Name:
D/B/A Name:
Physical Address:
City:
State:
Zipcode:
Business Phone:
Business Fax:
Email:
Est. Total Monthly Sales:
Est. Monthly Credit Card Sales:
Years in Business:
Banking Institution for Business Account(s):
Has this Bank Account Been Open for at Least 90 Days? Yes No
Time Remaining on Site Lease/Mortgage:
Business Type:
Landlord/Agent Name:
Landlord/Agent Phone # :
Number of Locations:
9 Digit Federal Tax ID #:
Is Your Business for Sale? Yes No
$ Amount Requested:
Have you ever filed for bankruptcy?: Yes No
Intended Use of Money:
Do you have any federal or state tax liens?: Yes No
Type of Entity (Corporation, Sole Proprietorship, etc.) :
Name of Authorized Signer :
Title of Authorized Signer:

Principal Owner Information (Please Complete ALL Information Below Accurately)

Are you a USCitizen or Permanent Resident? Yes No
% Ownership:
Score :
Principal Owner Name :
Social Security #:
D.O.B:
Home Address:
City:
State:
Zipcode:
Home Phone:
Mobile:
How Long at Home Address:
Number of years at previous home address:
Own Or Rent

You are accepting the terms and conditions of countrywide capital

Signature of Merchant Authorized Signer & Loan Guarantor:

Date :
Merchant Authorized Signer’s Title:

Universal Merchant Credit Application For Co-Guarantor ARF Financial LLC

Merchant Information (Please Complete All Information Below Accurately)

Legal Name of Merchant:

D/B/A Name of Merchant:

Merchant Corporate/Legal Address:
City:
State:
Zipcode:
Phone:
Fax:
Web Site Address:

Information on Loan Co-Guarantor ()

Name of Guarantor :
Date of Birth:
Social Security Number:
Drivers License #:
State:
E-Mail Address:
Home Address:
City:
State:
Zipcode:
Home Phone:
Cell Phone:
Do You Own or Rent? Own Rent
How Long? Years Months
Have You Declared Personal Bankruptcy in the Past? Yes No
When?
Do You Currently Have Collection Issues Pending? Yes No

You are accepting the terms and conditions of countrywide capital

Signature of Merchant Authorized Signer:
Date :
Signature of Co-Guarantor:
Date :

1. This application must be completed in its entirety. It must be signed and dated by an Authorized Signer of the Merchant and the Loan Co-Guarantor.

2. How would you (Co-Guarantor) like to be contacted about this financing request?

Business Phone Cell Phone Home Phone E-Mail Business Fax

Transmittal of this Application and all information to be attached may be made by facsimile transmission.

PLEASE FAX THIS APPLICATION TO:

Source of Application (For Office Use Only)

Sales Rep Name :
Sales Rep E-Mail :
Company Rep Works For :
Company ID Number :
Sales Rep Phone Number :
Date Submitted :