O N L I N
E A P P L I C A T I O N
$10,000 to $100,000
You must be
a registered Annual Broker participating in
one of our affiliated pay-in programs to submit
this loan request. Brokers in active status may
submit this application at time of new account
activation or at anytime during the annual term
of the effective date of service. There is no
application or processing fees billed to Annual
Brokers when they have met funding volume
guidelines. If not, you will be billed
accordingly. ► Application
Fee: $495.00 ► Personal Credit
Report Fee: $85.00 ►
Total Due: $580.00►
Pay By Check By Fax >>►
For more Payment Options Click Here >>► Return by email to:
Broker_Financing@artistic-capitalcorp.com
Broker
Name:
Broker ID#:
Fax
#:
Annual Income:
Email Address:
Marital Status:
BUSINESS INFORMATION:
Business Name:
Physical Street Address:
City:
State:
ZIP:
Phone:
D&B #:
Time
under Current
Ownership, MO/YR:
Annual Revenue:
Annual Profit:
Type
of Business:
Type
of Ownership
Federal Tax ID#:
Annual Losses:
PRINCIPAL(S)
Name:
Title:
Mother's Maiden Name:
Social Security #:
Date of Birth:
(Ex.: 01-24-66)
Home
Street Address:
City:
State:
ZIP:
CO-SIGNER
Name:
Title:
Mother's Maiden Name:
Social Security #:
Date of Birth:
(Ex.:
01-24-66)
Home
Street Address:
Annual Income:
City:
State:
ZIP:
CO-SIGNER EMPLOYER
Business
Name:
Title:
How long employed:
Annual Salary:
Start Date:
(Ex.: 01-24-66)
Street Address:
City:
State:
ZIP:
BANK
REFERENCE(S)
Name
of Bank:
Average Balance:
Checking Acct #:
ABA Routing #:
Phone
Contact Person
TRADE
REFERENCE 1
Company:
Credit Limit:
Phone:
Contact Person:
TRADE
REFERENCE 2
Company:
Credit Limit:
Phone:
Contact Person:
TRADE
REFERENCE 3
Company:
Credit Limit:
Phone:
Contact Person:
DESCRIPTION OF
EQUIPMENT (ASSETS OWNED):
Example: Desktop Computer, HP, $4,500
Please List Approximately $7,500 in equipment or
more that you own. If you do not own equipment,
credit score is low, or you do not have assets
to list; please provide co-signer information
above to process your funding request.
If
you do not have equipment assets to list, please
provide Investments, Stock, Bonds, etc.
Description or
Bank
Manuf.
or Real Estate
Appr.
Cost / Value
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
Broker Certification & Agreement:
Broker making this request for funding placement confirms that he/she is an
annual broker registered in Artistic! Capital Corporation's Brokers Program
and that he/she has elected at least the 10% participation level or higher
in order to submit this request. If participation level is lower than 10%
Broker understands that the standard application for placement of $895.00
up to $100,000 is required in order to process this request. Broker agrees
that he shall be solely responsible for the total amount secured for him/her
and/or his/her business and shall sign Artistic!'s Commitment Agreement when
executed and return it accordingly with Notary Public signature and dated.
Broker confirms that he has been notified that he shall be invoiced at a
lower rate due to his participation with this agency and shall only be
required to pay the agency 14.9% of any amount approved up to $100,000 when
invoiced by agency when lender meets the approval requests of the agency on
the broker's behalf. Broker understands that he/she shall not be paid his
participation level commissions for any funding request approved on his/her
behalf, and that he/she shall not default on any approval when notified by
agency.
Broker understands that his/her Broker's Account must be in good standing in
order to submit this request for funding, and that he/she must have met his/
her minimum monthly quota allowance of at least five (5) funding placements
before this application can be submitted to agency for consideration. The
Broker's signature below confirms that he/she has met all agency minimum
requirements for processing this request and that he/she may submit as noted.
Broker's signature below confirm his/her acceptance of this agreement and
that he shall abide by the terms and conditions as they have been presented.
Broker Signature: Date:
If faxing, provide original signature below and date where applicable.
____________________________________ Broker Account #: ___________________
Broker Signature (Original by Fax)
____________________________
Date
To send by email, type information and cut/paste into email.
If paying by fax, attach your check payment.
(Make checks payable to Artistic! Capital Corp.)
Fax to: 1-866-RTISTIC! (1-866-784-7842) 24/7TURNAROUND TIME: All Broker funding requests will be processed in the order in which they are received
Standard turnaround time is 10-12 business days from the date your application has been submitted. If you
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