H & J Capital Group Application Form

H and J Capital Group is a proud supporter of COALITION FOR THE HOMELESS OF CENTRAL FLORIDA our mission is to is to help families and individuals find their way home with a focus on housing and income. To give thanks in your trust in partnering with us and most importantly supporting our mission H and J Capital Group will donate $50.00 to this Organization with each new customer we acquire.

Business Information

* Business DBA Name

* Business Legal Name

* Business Street Address

* City, State, Zip Code

* Main Contact

Office Number

* Cell Phone Number

Federal Tax ID# (Required for partnerships & Corporations)

* Email Address

Website

Number Of Locations

Years In Business

Years With Current Ownership

Existing Credit Score

Type Of Ownership

Sole Proprietorship

Partnership

Corporation

Government

Limited

Liability (LLC)

Tax Exempt Org.

Medical Corporation

Association/Estate/Trust

International Organization

If Corporation, What is the state of incorporation?

Type of Goods Sold and / or Services Offered

Type Of Business

Retail Storefront

Restaurant

Hotel/Lodging

Service

Mail/Telephone Order

Internet

Trade Show

Kiosk

Other

Cash will be used For

Expansion

Renovations

Equipment

Inventory

Location

Cash Flow

Pay Taxes

Marketing

Pay Off Excisting/Loan

Other

Ownership Information

* Name

Title

Ownership Percentage

Address

City, State, Zip Code

* Phone Number

* Date Of Birth

Social Security Number

Partner Information(Require if than 51% ownership)

Corporate Office/Owner Name

Title

Length Of Ownership

Ownership%

Home Address

City

State

Zip Code

Date Of Bith

Social Security Number

Home Phone Number

Cell Phone Number

Financial Information

Average Monthly Total Sales

Average Monthly Credit Card Sales

Desired Advanced Amount

Date Cash Needed

Daily Payment can afford

Would you prefer Bi-Weekly/Monthly

Rent Mortgage

Landlord/Mortgage Company

Landlord Contact Name

Rent Mortgage Payment

Landlord Contact Phone Number

Lease Expiration Date

Have you used a cash advanced program before ?

Yes

No

Do you have an OPEN cash advanced ?

Yes

No

Are there any State Tax Liens/ Federal Tax Liens pending against the business owner? Are you on a payment plan ?

Yes

No

Has the business or any of its owners ever declared bankruptcy

Yes

No

Existing Open Cash Advances

Are you current on your cash advances

Yes

No

Name of lender 1

Current Balance 1

Amount Funded 1

Do you wnat to py them Off 1

Date Funded/Length of Cash Advanced 1

Name of lender 2

Current Balance 2

Amount Funded 2

Do you wnat to py them Off 2

Date Funded/Length of Cash Advanced 2

Name of lender 3

Current Balance 3

Amount Funded 3

Do you wnat to py them Off 3

Date Funded/Length of Cash Advanced 3