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Small Business Consulting www.dan-norwood.com 866-200-2352
Dan Norwood dan@dan-norwood.com 714-618-4010
dnrefi@sbcglobal.net www.crosslateralgolf.com
Business Legal Name
Business Structure ___ Home Based ___ Franchise ___ E-Commerce ___ NA
Type of Business ___ Sole Proprietor ___ Partnership ___ Corporation ___ LLC ___ LLP
Federal ID #
Loan Amount
State ID # Workers Comp Carrier
# of Employees # of Locations
Physical Phone Cell Phone Other Contact #
State of Corporation Length of Ownership How many Principals
Gross Monthly Sales Average Transaction Amount Gross Annual Sales (Prior yr tax return)
# of banks deposits (90 days) # of returned check fees Industry Type SIC or Description
Average Depsosits 2 months Average Deposits 4 months Annual Credit Card Sales
List of total credit card volume
Average Monthly Credit Card Volume
# of days with a negative balance
Average Deposits 3 months
Last month $_____________ # Tickets ______
Loan Terms
Does Merchant have any open contracts for
working capital ___ Yes ___ No
Prior Month $_______________ # Tickets __________
Prior Month $_______________ # Tickets __________
Business Credit Score
Funding Information: Visa/MC Card Swipe _______% Manually Keyed ______% Phone/Mail Order ________% Internet ________% Other ________%
Billing Address Location
Physical Address Location
Fax #
Date Business Started
Fico Primary Contact Net Worth Principal/s Renting or Leasing Business Property
Landlord Contact Name Monthly Rent Square Footage
Primary Contact Number Job Title
Fico Primary Contact Net Worth Principal/s
Net Worth Principal landlord Phone #/Landlord
Principal First Name SS # Date of Birth
United States Citizen ___Yes ___No
Legal Alient ___Yes ____ How long
Business Bank Phone Number Fax Number
Business Bank Phone Number Fax Number
Personal Bank Phone Number Fax Number
Trade References
Business Name Phone Number Fax Number
Business Name Phone Number Fax Number
Applicant authorizes Dan Norwood Enterprises to submit on applicants behalf the above transaction to a lender, lenders agent, it's assigns, banks or
financial instution to obtain an investigative consumer and business report from a credit bureau or a credit agency and to fully investigate the
references, trades, leases and any other pertinent information given on any othe statement of data obtained from applicant in order to process their
application. This includes, but is not limited to speaking with landlords and management agencies
Contact
Contact
Contact
Contact Name
Contact Name
Owner/Officer
Principals Address City State Zip Code County
Lease Start Date Lease Term
Net Woth Business
Last Name
Applicants Signature Date
Applicant authorizes Dan Norwood Enterprises to submit on applicants behalf the above transaction to a lender, lenders agent, it's assigns, banks or
financial instution to obtain an investigative consumer and business report from a credit bureau or a credit agency and to fully investigate the
references, trades, leases and any other pertinent information given on any othe statement of data obtained from applicant in order to process their
application. This includes, but is not limited to speaking with landlords and management agencies
## of credit card terminals terminal make and model Own or Lease Equipment Monthly Payment and term

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03-2015 Merchant Loan Application Page 1

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03-2015 Merchant Loan Application Page 1