Grade A Funding Application

Date

Field is required!

Legal name of company

Field is required!

Registered Trade Name (D.B.A):

Field is required!

Physical Address:

Field is required!

City:

Field is required!

Zipcode

Field is required!

Mailing Address:

Field is required!

City:

Field is required!

Zipcode

Field is required!

Email Address:

Your E-mail Address

Field is required!

Federal Tax ID #:

Field is required!

US DOT #:

Field is required!

Phone:

Field is required!

ICC-FHWA #:

Field is required!

Year Established:

Field is required!

Fax:

Field is required!

DUNS #:

Field is required!

Total Employees:

Field is required!

Year filed

Field is required!

Commodity Hauled

Institution:

Field is required!

Address:

Field is required!

Owner Information

Name:

Field is required!

Home Address:

Field is required!

Title

Field is required!

Ownership %

Field is required!

City

Field is required!

Home Phone

Field is required!

DOB:

Field is required!

Driver's License #:

Field is required!

Social Security #:

Field is required!

Zipcode:

Field is required!

Expiration:

Field is required!

Bank References

1

Institution:

Field is required!

Address:

Field is required!

Contact:

Field is required!

Phone:

Field is required!

City

Field is required!

Fax:

Field is required!

Zipcode:

Field is required!

Account number:

Field is required!

2

Institution:

Field is required!

Address:

Field is required!

Contact:

Field is required!

Phone:

Field is required!

City

Field is required!

Fax:

Field is required!

Zipcode:

Field is required!

Account number:

Field is required!

3

Institution:

Field is required!

Address:

Field is required!

Contact:

Field is required!

Phone:

Field is required!

City

Field is required!

Fax:

Field is required!

Zipcode:

Field is required!

Account number:

Field is required!

Miscellaneous Information

How did you hear about Grade A Funding?

Field is required!

What is the estimated monthly sale volume?

Field is required!

What amount of your monthly sales volume will you finance?

Field is required!

What is your average invoice amount?

Field is required!

Have you, this company, it's officers or directors, or any affiliated companies ever

W-9 (must be signed and dated) (Print)

Upload your documents...

Field is required!

Copy of Authority Letter (MC Letter)

Upload your documents...

Field is required!

Copy of Corporation/LLC documents including articles of organization or articles of incorporation

Upload your documents...

Field is required!

Certificate of Insurance

Upload your documents...

Field is required!

Owner/Officer 1 Driver's License

Upload your documents...

Field is required!

By executing this application, the undersigned person(s) certifies to the following: The information set forth in this application and in the documents, schedules, reports, statements, and/or other information provided to Grade A Funding with or pursuant to this application are full, true, correct, and complete and accurately reflect such information on the date(s) thereof; that Grade A Funding is authorized to request, receive, and verify credit reports and other financial information regarding applicant(s) and its business that Grade A Funding deems necessary and appropriate that Grade A Funding is authorized to execute in the name of the undersigned person( s) and file against the undersigned person(s) in favor of Grade A Funding financing statements with respect to the undersigned person(s) assets ; and that Grade A Funding is authorized to inquire of, investigate, confirm, and verify any information contained in this application, in any document s, schedules, reports, statements, and/or other information provided under or pursuant to this application, or learned by Grade A Funding Inc. as part of its investigation and review of this application, applicant(s ), or applicants business.

Owner/Officer 1 Signature

Field is required!

Submitting this form with your electronic signature binds you to the agreements listed above

Submit