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Amount of Financing Desired
COMPANY INFORMATION Company Name Date Business AddressCity StateZip Code Phone (Include Area code) Business Fax (Include Area code) Cell Phone (Include Area code) Federal Tax ID# Business Type Time In BusinessEmail Address (Required) Best Time to Call
BANK REFERENCES Bank NameBank Phone (Include Area code) Checking Account #
TRADE REFERENCES Company Phone (Include Area code) Acct # Company Phone (Include Area code) Acct #
PLEASE COMPLETE BELOW SECTION FOR EACH OWNER OF THE COMPANY
OWNER 1 INFORMATION Legal NameSocial Security #% of Ownership
Home Address City State Zip Code Phone (Include Area code)
OWNER 2 INFORMATION Legal Name Social Security # % of Ownership Home Address City State Zip Code Phone (Include Area code) OWNER 3 INFORMATION Legal Name Social Security # % of Ownership Home Address City State Zip Code Phone (Include Area code)
By signing below or agreeing, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to IAM or its designee (and any assignee or potential assignee thereof) authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat or facismile copy of this authorization shall be valid as the original. By signing or agreeing, I/we affirm my/our identity as the respective individual/s identified in the above application. This is also authorization to release Bank and company credit reference information to IAM or its assignee(s).
This is also authorization to release Bank and company credit reference information to IAM Ventures LLC or its assignee(s).
I Agree I Disagree
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Call us toll free at 866-300-2070 and one of representatives will take your application over the phone.
Print and complete this application form and fax it to 866-542-5615.
Print and complete this application and mail it to us at:
IAM Ventures LLC 2241 #358 State Street New Albany IN, 47150