Grade A Funding Application

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Legal name of company
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Registered Trade Name (D.B.A):
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Physical Address:
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City:
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State
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  • Alabama
  • Alaska
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  • California
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  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Zipcode
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Mailing Address:
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City:
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Zipcode
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Email Address:
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Federal Tax ID #:
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US DOT #:
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Phone:
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ICC-FHWA #:
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Year Established:
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Fax:
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DUNS #:
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Total Employees:
-
+
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Type of Business
  • - select a option -
  • Proprietor
  • Partnership
  • LLC
  • S-Corp
  • Corporation
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Year filed
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Transporter type:
  • - select a option -
  • First choice
  • Second choice
  • Third choice
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State:
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  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Commodity Hauled

General:
  • - select a option -
  • Yes
  • No
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Tank:
  • - select a option -
  • Yes
  • No
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Other:
  • - select a option -
  • Yes
  • No
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Bulk:
  • - select a option -
  • Yes
  • No
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Refrigerated:
  • - select a option -
  • Yes
  • No
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Institution:
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Address:
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Owner Information

Name:
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Home Address:
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Title
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Ownership %
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City
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Home Phone
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DOB:
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Driver's License #:
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State:
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Own:
  • - select a option -
  • Yes
  • No
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Social Security #:
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State Issued:
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Zipcode:
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Rent:
  • - select a option -
  • Yes
  • No
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Expiration:
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Bank References

1

Institution:
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Address:
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Contact:
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Phone:
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City
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Fax:
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State:
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Account Type:
  • - select a option -
  • Checking
  • Savings
  • Independent Loan
  • Lease
  • Other
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Zipcode:
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Account number:
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2

Institution:
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Address:
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Contact:
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Phone:
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City
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Fax:
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State:
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Account Type:
  • - select a option -
  • Checking
  • Savings
  • Independent Loan
  • Lease
  • Other
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Zipcode:
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Account number:
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3

Institution:
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Address:
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Contact:
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Phone:
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City
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Fax:
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State:
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Account Type:
  • - select a option -
  • Checking
  • Savings
  • Independent Loan
  • Lease
  • Other
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Zipcode:
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Account number:
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Miscellaneous Information

How did you hear about Grade A Funding?
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What is the estimated monthly sale volume?
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What amount of your monthly sales volume will you finance?
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What is your average invoice amount?
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Do you use an outside accounting firm?
  • - select a option -
  • Yes
  • No
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Do you use a payroll service?
  • - select a option -
  • Yes
  • No
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Do you use products or services from your customers?
  • - select a option -
  • Yes
  • No
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Do you currently have a fuel card?
  • - select a option -
  • Yes
  • No
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Have you given a security interest in, or made an assignment of, your accounts receivable or inventory as collateral to any other creditor?
  • - select a option -
  • Yes
  • No
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Have you, this company, it's officers or directors, or any affiliated companies ever

Been convicted of a felony?
  • - select a option -
  • Yes
  • No
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Filed bankruptcy or had a petition in bankruptcy filed against it?
  • - select a option -
  • Yes
  • No
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Had a receiver appointed?
  • - select a option -
  • Yes
  • No
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Had or have a Federal, State, County, or Municipal lien/levy filed against it?
  • - select a option -
  • Yes
  • No
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Are any federal and/or state taxes past due?
  • - select a option -
  • Yes
  • No
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Been involved in or are currently engaged in, or threatened with any litigation?
  • - select a option -
  • Yes
  • No
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Do you receive trip advances from your customers?
  • - select a option -
  • Yes
  • No
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W-9 (must be signed and dated) (Print)
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Copy of Authority Letter (MC Letter)
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Copy of Corporation/LLC documents including articles of organization or articles of incorporation
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Certificate of Insurance
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Owner/Officer 1 Driver's License
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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
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Submitting this form with your electronic signature binds you to the agreements listed above