LOAN REQUEST FORM 
APPLICANT COMPLETE ALL AND RETURN BY FAX, EMAIL OR DIRECTMAIL

TODAY’S DATE

 

AMOUNT REQUESTED
($10,000-$500,000++)

$

APPLICANTS NAME

 

EMAIL

 

SS#

 

DOB

 

MOTHER'S MAIDEN NAME

 

ADDRESS

 

COUNTY

 

HOME PHONE#

 

CELL PHONE #

 

MARITAL STATUS

 

MORTGAGE

HOLDER NAME

 

HOME VALUE $ (IF N/A THEN MONTHLY RENT PAYMENT)

$

MORTGAGE BALANCE

Monthly Payment

$

 

 

$

DRIVER'S LICENSE #

 

STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

TITLE

 

IF SELF EMPLOYED:

% OWNED

 

DATE OF INC.

 

STATE

 

D & B #

 

EIN #

 

ADDRESS

 

PHONE #

 

FAX #

 

ANNUAL INCOME

$

OTHER ANNUAL

 $

SOURCE OF ADDITIONAL INCOME

 

IF SELF EMPLOYED:

ANNUAL GROSS SALES

 $

ANNUAL LOSSES

 $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                     

 HOW LONG EMPLOYED?

YEARS 

MONTHS

FAX # WHERE YOU CAN RECEIVE CONFIDENTIAL INFORMATION?

FAX # 1

FAX # 2

 

        APPLICANT ONLY                                                 APPLICANT ONLY

BANKING INFORMATION:

TYPE OF ACCOUNT

(BUSINESS/PERSONAL)

 

BANK NAME

 

ACCT. #

 

ADDRESS

 

CONTACT PERSON

 

PHONE #

 

CURRENT BALANCE

$

AVG BALANCE

$

 

 

 

 

 

 

 

 

 

 

 

 

 
If you have an American Express Account number, have not ever been delinquent or pastdue, or you have a Zero (0) balance with this lender, and your account presently is in excellent standing; please provide your American Express Account number in order for our agency to expedite faster processing of an approval for your application.  If you had a previous American Express Account and it has not been used for a while, please note below and provide your number as reference.
 

AMERICAN EXPRESS ACCOUNT #

 


Applicant confirms that the information contained in the LOAN REQUEST FORM is accurate, correct, and true to the best of his/her ability. Applicant understands that submittal of this form is not a guarantee of credit and/or an approval thereof, but constitutes the right of the Lender, its affiliates, assigns, and assessors to review, process, and/or consider an extension of credit to the Applicant whose signature appears below who meets standard pre-approval requirements for funding per the request indicated.  Standard Application Fee of $895.00 is required to process this request for each applicant applying up to $300,000 and $1,595.00 is required if funding placement request is over $301,000.  Applicant understands that he/she must provide a Tri-Merge personal credit report in order to submit this request to the agency.  Otherwise, an $85.00 Credit Report Fee is required for each applicant applying.  (Make all payments by Cashier’s Check and/or Money Order to:  ARTISTIC! CAPITAL CORPORATION and return to Broker who provided the form to applicant or fax directly in to the agency with your personal or business check.)  By directmail, we accept only Cashier's Checks and Money Orders for your placement fee.

When finished submitting your payment, print out this form and fax it immediately to: 1-866-784-7842 (24 hours per day, 7 days per week).  The Broker submitting this request will notify you immediately of your approval and the amount you have pre-qualified for.  If you are contacting the agency directly, you will be notified within 24-48 hours of your pre-approval status and whether your funding request has been pre-approved or not.  All application and processing fees are NON-REFUNDABLE at time of submittal and will not be returned for any reason.  To ensure the approval on your application, please make certain that your personal Fico Score is at least 690-850 in order to be considered for Lines of Credit, Business Loans, Working Capital Loans or Expansion Loans in the amount of $10,000 to $800,000. 

 

 Applicant Signature____________________________________         Date _____________________
 

If personal guarantor, please provide your Signature above or if you are a Co-Signer for an application already in progress.
If you require a CO-SIGNER, complete Co-Signer to complete section below where indicated.
 

 If a Business, additional Officers signatures are required below:
 

 ______________________________ Title___________________ Date______________  

Officer's Signature                             SS#:  ___________________  DOB:  ____________

 

______________________________ Title___________________ Date______________  

Officer's Signature                             SS#:  ___________________  DOB:  ____________


Broker of Record:  __________________________________   Telephone #:  _________________

 

RETURN THIS FORM BY EMAIL AND/OR FAX TO:
1-866-784-7842 (FAX 24 hours per day, 7 days per week)
AcctSrvs@artistic-capitalcorp.com 

 

FAX INSTRUCTIONS:
1.  Complete form and fax to:  1-866-784-7842.
2.  Write out your payment check for your personal credit report and
     and your Application Fee, made payable to Artistic! Capital Corp.
     and fax with your application.  * DO NOT VOID YOUR CHECK *
3.  Download your Tri-Merge Personal Credit Report from our website
for less than $40.00 right now and return with your Loan Request Form.
4.  You will be notified of the exact amount you are pre-approved for
     within 24-48 hours of our receiving your Loan Request Form and
     personal credit report payment.
5.  If DECLINED for any reason or we cannot accept your request, we
will immediately return your payment the same day. 

DIRECTMAIL YOUR REQUEST:
1.  Complete application in its entirety and return with your personal
     or business check as advised for your personal credit report fee.

2.  Send by FEDEX, UPS, or Priority Mail, Next-Day Air Delivery
     or Priority Mail for immediate processing.  We process requests
     by overnight services the fastest.  (Regular Mail, will be processed
     in the order in which it was received.)
 

3.  Overnight or Mail to:
Artistic! Capital Corporation
ATTN: PLACEMENT APPROVALS
1940 Deer Park Ave., Ste. #254
Deer Park, NY  11729-3328


©2000-2004 Artistic! Capital Corporation; ALL RIGHTS RESERVED.