Versara Financial: No-Obligation Form

NO-OBLIGATION LOAN / LEASE APPLICATION

Versara Financial will use this information to identify potential lenders. The information you provide will be subject to verification prior to loan funding. All information provided by you will be kept strictly confidential and be delivered in a secure method to a lender.

PRINCIPAL'S NAME:
Title:
Company name:
Street Address:
City / Town:
State / Province:
Zip / Postal Code:
Telephone Number:
Cellular Phone:
Fax:
Email:
	Start-up	Existing Business	Years in Business:
	Sole Proprietorship	Partnership	Corporation
Industry:
Amount of Financing Requested:

Purpose of Financing:	Franchise Purpose	Equipment Financing	Start-up Financing
	Working Capital	Receivables Financing	Factoring
	Other (Please Specify):

Briefly Describe the purpose of Financing:
Personal Guarantees Available:	Yes No
Credit History of Owner:	Excellent	Satisfactory	Poor
Credit History of Company:	Excellent	Satisfactory	Poor
If a Business Purchase:	Purchase Price $
	Cash Invested by Buyer $
	Total Business Assets $
	Total Liabilities $
	Total Business Net Worth $
	Company's Annual Revenue $
	Company's Annual Profit $

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