Online Application Form | Porter Capital

Online Application

Use this online application to provide Porter Capital with detailed company information.

- Step 1 of 5

Company Information (continued)

Brief Company Description *

Type of Business *

S-Corporation
C-Corporation
LLC
Partnership
Sole Proprietor

Do any of the following apply?

Consignment Sales
Guaranteed Sales
Progress Billing
Milestone Billing
Bill and Hold Sales

Do you purchase goods or services from your customers?

Selling Terms

Net 30
Net 45
Net 60
Net 75
Other

Other Selling Terms Description

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Financial / Background Information

How much was last year's revenue?

How much is this year's revenue so far?

What are your average monthly sales?

Do you have any secured debt, factoring, merchant cash advances, or bank debt? *

Who is the lender and how much is owed?

Is your company current on taxes? *

How much is owed in taxes? *

Have you ever filed personal or business bankruptcy? *

Which type and what date(s)? *

Do you have any pending liens, judgements, or criminal records? *

Pending liens, judgements, or criminal records description *

If you choose to upload an accounts receivable aging report, it can help our underwriters process your application more quickly.

(Optional) Upload a detailed accounts receivable aging report

Click or drag a file to this area to upload.

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Contact Information

Your Full Name *

Your Job Title *

Your Email *

Your Phone Number *

Are you an owner of at least 20% of the company? *

What is your ownership percentage? *

Your Social Security Number *

Your Date of Birth *//

Your Address *

Address Line 1

Address Line 2

City

State

Zip Code

Your Driver License (optional)

Click or drag a file to this area to upload.

Owner Information

Additional Owners

Please provide information for every owner of at least 20% of the company.

Are there any owners of at least 20% of the company? *

Are there additional owners of at least 20% of the company? *

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Date of Birth *//

Owner Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Driver License (optional)

Click or drag a file to this area to upload.

Are there additional owners of at least 20% of the company? *

Owner Information

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Date of Birth *//

Owner Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Driver License (optional)

Click or drag a file to this area to upload.

Are there additional owners of at least 20% of the company? *

Owner Information

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Date of Birth *//

Owner Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Driver License (optional)

Click or drag a file to this area to upload.

Are there additional owners of at least 20% of the company? *

Owner Information

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Date of Birth *//

Owner Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Driver License (optional)

Click or drag a file to this area to upload.

Are there additional owners of at least 20% of the company? *

Owner Information

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Date of Birth *//

Owner Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Driver License (optional)

Click or drag a file to this area to upload.

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This form authorizes Porter Capital Corporation (PCC) to verify with third parties in any manner it deems appropriate, your financial condition, credit history, assets and any items indicated on this or other statements provided to PCC by your organization, its officers, directors, or principals and; authorizes PCC to conduct any and all references and background investigations related to your respective character and reputation and hereby irrevocably release and holds harmless PCC from any claim of any kind related to or arising out of any such investigation. PCC will be promptly notified of any intended changes in the facts concerning your organization, name, places of business, authorities and other matters presented. According to the Fair Credit Reporting Act, I am entitled to know if credit is denied because of information obtained by you from any consumer reporting agency. If so, I will be so advised and be given the source of the information. I/We grant Porter Capital Corporation or its agents the right to file a UCC-1 Financing Statement listing all assets as the collateral description.

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