NEW CLIENT APPLICATION 
Personal - $10,000 to $100,000 ● Business - $30,000 to $500,000+
FAX TO:  1-631-851-8783 (24 Hrs/7 Days)

□ HomeOwner □ Renter □ Rent w/Option □ Live with Relatives □ Other

MORTGAGE PAYMENT:  $_____________   MORTGAGE BAL.: $______________

CREDIT CARD BALANCES.: $_____________     TOTAL DEBT:  $______________

BANK NAME:  _______________________________  
CURRENT BAL.: $____________________________

BANK TEL. # (WITH AREA CODE):

MORTGAGE PAYMENT:  $_____________    MORTGAGE BAL.: $______________

BANK NAME:  _______________________________  
CURRENT BAL.: $____________________________

BANK TEL. # (WITH AREA CODE):

□ 100%  □ 75%  □ 50% □ 25% □ 15% □ 10%  □ Other:  ______

□ Sole-Owner □ 2 Owners □ 3 Owners □ 4 Owners □ 5 Owners

□ C-Corp. □ S-Corp. □ LLC □ Partnership □ Sole-P □ Aged/Shelf Corp.

□ Annual Revenue $ _____________    □ Annual Losses $ ________________

□ Long-Term Debt $ ____________   □ Current Monthly Debt $ ____________

BANK NAME:  _______________________________  
CURRENT BAL.: $____________________________

BANK TEL. # (WITH AREA CODE):

PERSONAL REF. PHONE #:

PERSONAL REF. PHONE #:

PERSONAL REF. PHONE #:

PERSONAL REF. PHONE #:

PERSONAL REF. PHONE #:

BUSINESS REF. PHONE #:

BUSINESS REF. PHONE #:

BUSINESS REF. PHONE #:

BUSINESS REF. PHONE #:

BUSINESS REF. PHONE #:

COLLATERAL OFFERED:
(If any, please list.)

CLIENT ACKNOWLEDGEMENT & AGREEMENT:  Client confirms that he/she is the person named herein that owns and/or operates the business herein listed or he/she is an officer and/or employee of the business named and that he/she has authority to apply and/or request funding and/or credit related services on behalf of the business accordingly and has submitted this request for funding placement to the agency as required.  Client understands that he/she shall be considered an applicant for funding placement immediately when executing this application to Artistic! Capital Corporation with his/her personal Tri-Merge credit report that must not be older than thirty (30) days in order to be accepted.  Client understands there is an application placement fee required of $1,895.00 for any funding request up to $300,000.00 and $2,595.00 for any requests made through the internet totaling $301,000 or higher if not submitted by a registered broker and/or agent of Artistic! Capital Corporation, its assigns, assessors and/or affiliations.  EACH APPLICANT(S) MUST RETURN THIS APPLICATION WITH THE REQUIRED PLACEMENT FEES IN ORDER TO BE PROCESSED.  If you have a Co-Signer and/or Personal Guarantor, they must submit their placement fee for processing with your completed application or it will be returned to you rejected and unprocessed.  Any and/or all Co-signers and/or personal guarantors must return their Tri-Merge credit report for processing with this application.  Client understand that he/she must have a minimum personal fico score of at least 690-850 in order to submit this request and/or to be considered for funding placement services through this agency.  If client does not meet minimum requirements a Co-signer and/or personal guarantor will be required before funding placement will commence.  Client understands that the "Gray" shaded area within the contents of the application is for the Co-Signer and/or Personal Guarantor and that if this section of the application is completed that he/she must return his/her processing and placement fee with the application along with the placement fee of the Co-signer and/or Personal Guarantor to be considered.  Client understands that upon pre-approval execution by agency that he/she as well as any co-signers and/or personal guarantors will be required to sign before Notary Public the agency's Commitment Agreement before funding placement services will commence for either applicant(s).  Upon receipt of your payment and application the agency will immediately notify applicant(s) as to the status of their application within 24-48 hours from the date received.  Client understands that upon final closure of placement and client has been disbursed funds whether by loan check, line of credit check, bank wire transfer, business credit cards, and/or all other funding disbursements not mentioned; that he/she agrees to pay to agency its agency fee of 16.9% for any funding amount up to $300,000 and 18.9% for any amount approved or released to client(s) over and above $301,000 within 24-48 hours of receiving his approvals from any and/or all lenders as processed by this agency.  Agency shall accept approved line of credit checks from funding placement activity for client, bank wire transfers, money orders and/or cashier's checks as final payment once funded and no other payments from Client will be considered.  Client agrees that he/she shall be considered in default should he/she not pay agency its agency fees at time of release to client by any lender and that he/she shall be charged a default fee of $3,000 that will be due immediately upon notification by agency, and will remain responsible legally for all amounts not paid to agency as agreed (including collection, attorney fees, court fees, due diligence, bank fees, and any residual income lost by agency due to Client's default).  Client understands that the agency shall submit to a minimum of three (3) lenders to secure the maximum amount requested if not presented to one (1) lender for the entire amount.  Client understands that he/she has hired this agency for placement services and has requested that the agency represent him/her for all funding services as requested and that he/she shall hold the agency harmless for any declinations obtained for any reason by any and/or all lenders in any event.  Client understands that he/she may or may not have to provide additional financial verification documents, as well as identity verification information to the agency and/or to the lender making the final decision to approve any request submitted by agency.  Client understands that he/she shall remain responsible for any debts that may or may not incur due to the amount of funding approved through the agency on his behalf and that he/she may not at anytime indicate that he/she did not make the requests once the application has been submitted to the agency with the appropriate placement fees.  Client understands that all placement fees are NON-REFUNDABLE and shall not be returned to client at any time.  Signatures of all parties herein confirms receipt of this acknowledgement and all signers below agree to abide by the terms and conditions as they have been presented to them by agency.