Whitestone Fund
Office: (877) 224-5699
Fax: (877) 607-2525
www.whitestonefund.com

We require the following:
Copy of Driver’s License
Copy of Business License
Copy of Voided Check
4 Bank Statement

Agent:

BUSINESS INFORMATION

Legal Business Name:

DBA (If different):

Legal Entity:

Tax ID Number:

Business Classification:

Business Physical Address:

Business Phone:

Business Fax:

Products sold:

Email:

Length of ownership:

Years:

Months:

Monthly Credit Volume:

Monthly Deposit:

Annual Volume:

Landlord Name:

Contact Person:

Contact #:

Rent / Mortage Monthly Amount:

How long you have lived there:

OWNER PRINCIPAL INFORMATION 1

Name:

Home Address:

Home Phone:

Cell Phone:

Title:

% of ownership:

Drivers License#:

Email:

Date of Birth:

Social Security:

Personal Income:

OWNER PRINCIPAL INFORMATION 2 (if applicable)

Name:

Home Address:

Home Phone:

Cell Phone:

Title:

% of ownership:

Drivers License#:

Email:

Date of Birth:

Social Security:

Personal Income:

FUNDING INFORMATION

Desired Advance Amount:

Purpose of Advance use of Funds:

Current Cash Advance? YesNo

Company Name:

Balance:

Applicant authorize Whitestone Fund, its Assigns, Agents, Banks of Financial Institutions to obtain an investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant. Applicant, b signing below, represents that all the information is complete and accurate.

Print Name

Date

Co-Applicant

Date

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