PCG Financing Application

Application Form

Company Legal Name

Phone

Street Address:

Cell:

City, State, Zip:

Email:

State of entity filing:

Principals

% Owned

Title:

Cell Phone:

Email Address

% Owned

Title:

Cell Phone:

Email Address

Banking Information

Business Checking Account

Checking Account Number

Bank Office Phone #:

Period of Present Lease:

Name of Landlord and/or Management Company:

Phone Number:

Monthly Rental Amount: $

PO & Receivable Information

What is the purpose of the funds to be generated from financing?

Approximate number of customers:

Terms of Sales:

PO or Receivable amount you intend to sell on a monthly basis:

If YES, with what company have you/are you doing business with?

If YES, pledged to whom?

If YES, please list below and be specific:

What are your suppliers’ shipping terms?

General Information

If you answered YES to any of the above questions, please explain fully in the space provided below (use additional paper if necessary)

Please attach the following to this application form:

1. Company Financial Statements (P&L + BS+AR&AP aging…2 fiscal year statements, plus current month)
2. Accounts Receivable Aging + Accounts Payable Aging (as detailed as possible)
3. Last two years (completed) tax returns
4. Last 6 months of company’s bank statements
5. Articles of Incorporation and By-Laws + Certificate of Good Standing
6. Personal Financial Statements of Principals
7. Partnership Agreement (if applicable), and latest available capitalization table
8. IRS 941 Withholding Tax Filings and Proof of Payment
8. Sample of Company’s Purchase Orders, Invoices, Bills of Lading and Credit Memos
9. Copy of current Driver’s License

Applicant attests the foregoing information is true and correct to the best of my knowledge. Information is given to induce Pendleton Capital Group, Inc. (hereinafter “PCG”) to consider entering into a financing agreement with this company.

Applicant hereby authorizes PCG or any of its employees to examine its books and records, and to discuss the affairs, accounts and finances of the Applicant with Applicant’s officers and employees.

Applicant hereby authorizes its suppliers, customers, accountants, attorneys and employees to provide to PCG any information about Applicant and its affairs, finances and accounts as PCG or its employees may request. A copy of this authorization may be accepted as if it were an original.

Applicant hereby authorizes PCG or any of its employees to request a copy of a personal credit report, and a background report from any of the major credit reporting agencies.

Applicant Signature:

Date: