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AR/PO/Leasing Pre Application

	Accounts Receivable & PO Financing Request. The following request form is NOT an Application for Funding and is used as the first step in qualifying a business or company for financial and funding options available through our Funding Network. Please fill out form as completely as possibly. This will save us both a lot of time. Thanks in advance.
AR/PO/Other (*)	100,000 or Less250,000 or Less500,000 or less1 Million or less5 Million or less25 million or less25 million or more Invalid Input
Funding Amount Requested (*)	exact dollar amount no decimals
Legal Business Name
Business Address	Invalid Input
City State Zip	Invalid Input
Contact Person (*)	Invalid Input
Title	Invalid Input
Contact phone Number	Invalid Input
E-mail (*)	Invalid email address.
Business Web Site	Leave Web Address Blank
Type Of Financing	Accounts ReceivablePurchase Order Financingother Please specify your position in the company
Other Funding Requirements	Invalid Input
Reason For Funding	Invalid Input
Is this a start up, Start ups are less than 3 yrs old	YesNO Invalid Input
Datae Business Started	Invalid Input
Check one (*)	1 Corporation2 LLC3 Partnership4.Sole Proprietor Invalid Input
Type Of Business	1 Manufacturing2 Wholesale3 Retail4 Staffing Company5 Distributor6 Construction7 Franchise8 Transportation9 Medical10 Technology 11 Other Invalid Input
Type Of Product Or Service	Invalid Input
Number Of Employees	Invalid Input
Yearly Revenues	Please do not use decimals
D & B Credit Score	Invalid Input
Do You have a Business Plan or EXE Summary?	YesNo Invalid Input
Do you have a Company Balance Sheet?	YesNo Invalid Input
Does Your Company Prurchase Or Lease	YesNo Invalid Input
Is the An Emergency?	YesNo Invalid Input
Type of Funding request	Invalid Input
Additional Comments	Invalid Input
	Thank You for taking the time to fill out our lending request form, we will do our best to contact you with in 24 to 48 hours. Monday through Friday. You will be contacted by one of ELOC's Consultants by phone to set up an appointment to go over your business lending details. Please let us know the best time to call. If you should have questions or need assistance please email support@eloc.com. All information is kept confidential. We Look forward to working with you. Best Of Success Wm Cole Smith CEO/President ELOC Capital & Management Group

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