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

TODAY’S DATE

TOTAL FUND AMOUNT
TO DATE
(Ex. $30K-$50K)

APPLICANTS NAME

SS#

DOB

MOTHER'S MAIDEN NAME

ADDRESS

COUNTY

HOME PHONE#

CELL PHONE #

MARITAL STATUS

MORTGAGE

HOLDER

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

BUSINESS APPLICANT ONLY BUSINESS 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.

AMERICAN EXPRESS ACCOUNT #

Applicant confirms that the information contained in the FINANCE 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 an approval thereof, but constitutes the right of the Agency, 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 or has demonstrated a proven sales track record for lending referral services in a business of his/her own. Standard Application Fee of $850.00 is required to process this request, and an $85.00 Personal Credit Report Fee. (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 unless received by Corporate Offices of agency.) If paying online, see instructions below.

To pay application fee and personal credit report fee; CLICK HERE and pay online. 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 (if not the agency) submitting this request will notify you immediately of your approval and the amount you have been pre-qualified for. All application and processing fees are NON-REFUNDABLE unless we decline your application for any reason. To ensure the approval on your application, please make certain that your personal Fico Score is at least 690-950 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. If you are applying for a partnership or presently starting your own business, please select the annual participation fee for your request and return it immediately for further processing.

50% BROKER PROGRAM	50% of funded amount paid to agency	$ 6,595.00 Due at time of application.
50% PARTNER PROGRAM Includes all account setup and processing fees for registering and activating new account.	50% of total amount paid to agency. We pay all DUE DILIGENCE.	$ 8,764.00 Due at time of application. For Self-Employed or Start Your Own Business Applicants Only!!!

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)
Mylia_Spencer@Yahoo.com or TaraCMichaels@Yahoo.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. 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.
4. If approved for funding, you are required to pay your Application
     Fee immediately in order to process your request.

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: PAQUITA FIGUEROA
                                        342 E. Jericho Tpke.
                                        Mineola, NY 11501-2111