ARTISTIC! CAPITAL CORPORATION'S NEW CLIENT REQUEST FORM

NEW CLIENT REQUEST FORM

Please handwrite or fill in the following information as requested. When
received, we will forward you the necessary application for your request.
If your request is for Credit Enhancements, Lines of Credit, and/or you are
interested in purchasing an Aged/Shelf Corporation, please indicate this in the
comments section below. You will receive an immediate reply within 24 hours
of our receiving your request form and your comments. If you are interested
in a faster reply, please print out and fax your Request Form to us 24 hours
per day, 7 days per week to: 1-866-RTISTIC! (1-866-784-7842).

We look forward to servicing your needs.

Today's Date:

BROKER NAME: (If known)
Please complete all fields* below and submit by fax for the fastest reply. You must be at least 18 years of age to submit this form. We will process your request within one (1) business day or less.
REFERRED BY:
First/Last Name:
Business Name:
Title w/Business:
Address:
Ste.#, Room, Apt.#:
City:
State:
Zip:
Date of Birth:
Company:
Phone:	(With area code.)
Fax:	(With area code).
What is your existing fico score today? (Required)	□ 650 □ 690 □ 700 □ 750 □ 800 □ 850 □ ________
Email:
(Secondary) Email:
Will you require funding?	□ YES □ NO □ AMOUNT $ _______________
Will you require an Aged/Shelf Corp.?	□ YES □ NO □ HOW OLD? _______________
What is your maximum budget?	□ $10,000 □ $25,000 □ $50,000++ □ $ __________
Provide the date you would be ready to begin services?	□ TODAY □ IMMEDIATELY □ _____________________
Provide the main reason you decided to use our services?
Comments: (Please be very specific as to the type of service, program or offer you are replying to so that we can assist you appropriately.) Your comments are required in order for this request to be processed. If you do not provide comments where indicated, your request will not be processed quickly. Your cooperation is appreciated.
Fax to:	1-866-RTISTIC! (1-866-784-7842)
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