Compass Funding Services - Loan Request Form

Company Name
Contact Name				Business Phone
Address				Contact Number
City	State			Zip E-mail
Fax
Type of Business
	Date Established
Type of Entity Corporation Partnership Sole Proprietorship
Types of Financing:
			Loan Amount:

Ownership of Applicant Company List below all officers, directors, partners, owners & co-owners, all stockholders with 20% or more of total stock issued
Name	Title	% of Ownership		Annual Compensation




Last Years Gross:				Last Years Net:
Credit rating:
Borrower #1:	Poor Fair Good			Borrower #2:	Poor Fair Good

Affiliates List below all business concerns in which the applicant company or any of the individuals listed in the ownership section above have any ownership
Company Name	Owner			% of Ownership


Purpose of Loan::