Working Capital Credit Application
+++SalesRepName+++
Fax to: +++SalesFax+++ Phone: +++SalesPhone+++
Email to: +++SalesRepsEmail+++
23970 Highway 59 N, Kingwood, TX 77339
Company Information
Business Legal Name
DBA (if applicable)
Street Address
City
State
ZIP
Phone
Contact Name
Title
Cell
Email
Federal Tax ID
Years in Business Under Current Ownership
Industry Type
Website
Legal Structure
□ Sole Prop
□ Partnership
□ LLC
□ Corporation
# of Employees
□ Municipal
□ Not for Profit
Working Capital Information
Requested Amount
□ $25,000 □ $35,000 □ $50,000 □ Other:
Requested Term
□ 18 months □ 24
months
Business Purpose
Primary Bank Reference
Bank Name
Contact
Account #
Phone
Legal Name of Owners, Officers or Guarantors (please sign on the signature line)
(1) Name
Title
Social Security #
% Ownership
Email
Cell
Home Phone
Home Address
Signature X
Date
(2) Name
Title
Social Security #
% Ownership
Email
Cell
Home Phone
Home Address
Signature X
Date
Declaration/Release
By signing above, the applicant and the Owners/Partners/Members/Guarantors agree as follows: They certify that all information provided is true, correct and complete
and that the property leased or acquired with any credit provided will be used solely for business and commercial purposes. Providing an email authorizes Ascentium
Capital to email information about financing, promotions, and other offers. The applicant and the Owners/Partners/Members/Guarantors of the applicant listed above
recognize that their individual credit histories may be a factor in the evaluation of the applicant for the credit it is applying for and, thus, authorize Ascentium Capital LLC or
its designee to investigate their organizational and personal credit histories. This includes obtaining information from all sources including using their consumer credit
reports in the credit evaluation and collection processes, and to update any such information periodically.
+++spare1+++ +++The swollen Mississippi River rolled south Wednesday, swamping emptied-out towns and businesses, and threatening untold damage to
areas still recovering from a series of natural disasters. In Mississippi, Louisiana, and Arkansas, authorities and residents braced for the days ahead. I went
through (Hurricane) Katrina, said Lynn Magnuson, a New Orleans resident. I would not wish flooding on anyone, and this city is the last place on Earth that
needs any more high water. The river crested Tuesday at Memphis, just short of a record set in 1937.The river in Memphis measured 47.8 feet Tuesday
night, according to the National Weather Service. In Natchez, Mississippi, the river surpassed its record early Wednesday, exceeding 58 feet. Forecasts
predict the river will crest in Natchez on May 21 at an overwhelming 64 feet.+++
7998-20141022