BROKER CREDIT APPLICATION
      Personal Information            ____2% Program Election ($895.00 due to process.)

Last:                                            First:                                                      Middle Initial:

Title

Name of Business:

Tax I.D. Number

Address:

City:                                             State:                      ZIP:                                                        Phone:

Applicant Social Security #:                                        Date of Birth:                                 Mother’s Maiden Name:

 

     Company Information

Type of Business:                                                                                     In Business Since:

Legal Form Under Which Business Operates: 

State/Province:                                           Corporation  ð       LLC  ð  Partnership ð     Proprietorship ð   Non-profit ð  

If Division/Subsidiary, Name of Parent Company:                                                 In Business Since:

Name of Company Principal Responsible for Business Transactions:                 Title:

Address:                                    City:                                          State:           ZIP:                    Phone:

Name of Company Principal Responsible for Business Transactions:                 Title:

Address:                                    City:                                          State:           ZIP:                    Phone:

 

    Bank References

Institution Name:

 

Institution Name:

Institution Name:

Checking Account #:

 

Savings Account #:

Home Equity Loan:

Loan Balance:

Address:

Address:

Address:

Phone:

Phone:

Phone:

 

   Trade References

Company Name:

Company Name:

Company Name:

Contact Name:

Contact Name:

Contact Name:

Address:

Address:

Address:

Phone:

Phone:

Phone:

Account Opened Since:

Account Opened Since:

Account Opened Since:

Credit Limit:

Credit Limit:

Credit Limit:

Current Balance:

Current Balance:

Current Balance:

 

   Financial Information

Company Total Assets           Company Total Liabilities              Annual Net Income

Amount of Credit Requested:

 

Have you or your officers or affiliates ever filed a petition in bankruptcy?        Yes ð      No ð

Is your company subject to any litigation?      Yes ð      No ð             If so, describe:

 
* If new broker is applying for a loan or line of credit (at the same time) he/she is registering as an annual broker; provide your application fee of $375.00 plus your Tri-Merge credit report.  If personal credit report is not attached to the application at time of request, please include credit report fee of $85.00 (totaling $460.00 due with this application and your annual participation fee as elected for immediate processing. 
  

               Annual Participation Level:  (Circle or indicate your annual payout level below.)
                        ð 2%, $895.00*      ð 3%, $1,895.00    ð 5%, $2,395.00       ð 10%, $3,995.00
                        ð 25%, $6,595.00  ð 50%, $8,995.00  ð 50% Partner, $9,995.00
             * 2% program requires a standard acceptance application fee of $375.00 and a Tri-merge credit report.

I understand that I must make the annual participation buy-in level payment each year that I renew my annual brokering business with Artistic! Capital Corporation.  I understand that the 50% Partner Program is for individuals who can maintain a minimum monthly sales volume of $1,000,000.00 or more on funding leads submitted to agency.  Applicant(s) applying for 50% Partnership will be paid at 50% of the total funding amount charged to client, whereas 50% ($8,995.00 program) is paid out at 50% of the bottom-line costs paid to agency once all deductions, charges, fees, and discounts have been applied.

We declare that the above information is true, correct and complete and is given to induce  the purpose for Artistic! Capital Corporation to extend a placement request for credit as a commissioner should I or my business request funding with this application.  If not, I understand that I may apply for funding at anytime by submitting my request to Artistic! Capital Corporation.  I confirm that I will not be paid for any funding transactions processed for myself or my business, and I agree to pay to Artistic! Capital Corporation its standard agency fee of 14.9% on all funding transactions secured on my behalf up to $100,000.  Any amount over and above, $101,000.00 I realize that I will be billed out at 16.9% immediately. (I understand that registering as a broker that I am being discounted the agency's standard backend fees and the discount has been calculated as noted.)  I understand that I still must sign before Notary Public the agency's Commitment Agreement before I can be processed for any and/or all funding request placements that I make through this agency.  I realize that I must pay the agency immediately within 24-48 hours of receiving my funds through any lender who has approved me.  (Funding consists of all lines of credit, loan checks, bank wires, credit limits assigned via credit card whether personal or business.)

We authorize Artistic! Capital Corporation to make such credit investigation as the Company sees fit, including contacting the above trade references and banks and obtaining credit reports. I understand that I may waive the personal credit report fee if I am providing to agency my recent credit report not more than thirty (30) days old.  If I have not provided credit report, the $85.00 fee cannot be waived.  I understand that I may download and purchase a less expensive personal credit report from the website of the agency as a courtesy by visiting: http://www.artistic-capitalcorp.com/CREDIT-REPORTS.htm. We authorize all trade references, banks and credit reporting agencies to disclose to the Company any and all information concerning the financial and credit history of my company and myself.  I have submitted my Broker Credit Application for immediate consideration, along with my annual participation fee as noted herein as my selection.  I understand that I shall be notified of my acceptance within 24-48 hours from the date that the agency receives my completed application and payment.  I understand that should I be declined for any reason that I will be promptly refunded the amount paid for participation.  I understand that my personal credit report will be reviewed on to confirm my identity and for no other reason unless I have requested funding placement with my application.

I have read the terms and conditions stated above and agree to all of the terms and conditions.
 

Name of Company:                                                                   

Authorized Signature:                                                            

Title:                                                                                        

Printed Name:                                                                          

Social Security #:  ______________________________________

Business D&B #:  ______________________________________

Date of Birth:  ___________   Business Start Date:  ___________

Driver's License #:  ______________________________________

State Issuing Driver's License:  ____________________________

Telephone #: (with area code) ____________________________

FAX #: (with area code) _________________________________

Email Address:  _______________________________________

 

TOTAL ENCLOSED

    $
HOW PAID? (Cashier's Check, Money Order, Bank Wire Transfer, Personal or Business Check)  

* Please note that all Personal and Business Checks shall be held for 10 days to
  ensure that they are paid by your financial institution.  We reserve the right to
  charge a $100.00 return check fee on all dishonored checks, and will prosecute
  all bad-check writers.

                                                      Return Instructions: 
By FAX:  1-866-RTISTIC! (1-866-784-7842) or if busy use Fax #: 1-888-886-0058 24 hours per day, 7 days per week.
By Email:  If emailing, please put in .pdf file format before sending.  If this function is not available to you, please do
                 not return by email.  (Send by Priority, Express, or Overnight next-day airmail delivery.)
By Bank Wire Transfer:  You can request our bank wiring instructions upon our receipt and verification of your online
application.  To make your payment by Bank Wire Transfer, please include our $250.00 Bank Wire Fee to your total
when sending your payment.  When bank wire has been completed, fax a copy of your Bank Confirmation Form to us
at: 1-866-RTISTIC! (1-866-784-7842) 24 hours per day, 7 days per week for immediate Account Setup / Activation. To
request our Bank Wiring Instructions, send your confidential email inquiry to: bankwires@artistic-capitalcorp.com

If you have questions, send an email to: broker-signups@artistic-capitalcorp.com

 By Overnight:              ARTISTIC! CAPITAL CORP.
                                 ATTN: ANNUAL BROKER PROGRAM
                                 1940 DEER PARK AVE., STE. 254
                                 DEER PARK, NY  11729-3328   
                                
Referred By:  _______________________________________

©2002-2004 Artistic! Capital Corporation; ALL RIGHTS RESERVED.