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Tell Us About Your Financing Needs
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We look forward to connecting with you! To get started, please provide the following information.
Step
1
of
5
20%
Step 1: Business Info
Legal Business Name
*
In a few sentences, tell us about your business.
How much financing are you seeking?
How will you use the funds?
Business City
Business State
Telephone
*
Email
*
Step 2: Owner Info
Number of Owners
Select One
1
2
3
4
5
Owner 1
Owner 1 Name
Owner 1 Ownership %
Owner 1 Telephone
Owner 1 Email
Has Owner 1 ever filed for bankruptcy?
No
Yes
Date Owner 1 Filed for Bankruptcy
MM slash DD slash YYYY
Owner 2
Owner 2 Name
Owner 2 Ownership %
Owner 2 Telephone
Owner 2 Email
Has Owner 2 ever filed for bankruptcy?
No
Yes
Date Owner 2 Filed for Bankruptcy
MM slash DD slash YYYY
Owner 3
Owner 3 Name
Owner 3 Ownership %
Owner 3 Telephone
Owner 3 Email
Has Owner 3 ever filed for bankruptcy?
No
Yes
Date Owner 3 Filed for Bankruptcy
MM slash DD slash YYYY
Owner 4
Owner 4 Name
Owner 4 Ownership %
Owner 4 Telephone
Owner 4 Email
Has Owner 4 ever filed for bankruptcy?
No
Yes
Date Owner 4 Filed for Bankruptcy
MM slash DD slash YYYY
Owner 5
Owner 5 Name
Owner 5 Ownership %
Owner 5 Telephone
Owner 5 Email
Has Owner 5 ever filed for bankruptcy?
No
Yes
Date Owner 5 Filed for Bankruptcy
MM slash DD slash YYYY
Step 3: Location and Contact Info
Number of Locations
Select One
1
2
3
4
5
Are all lease/mortgage payments current?
No
Yes
Location 1
Do you lease or own location 1?
Lease
Own
Location 1 Monthly Lease/Mortgage Payment
Location 2
Location 2 City
Location 2 State
Location 3
Location 3 City
Location 3 State
Location 4
Location 4 City
Location 4 State
Location 5
Location 5 City
Location 5 State
Step 4: Financial Information
Are there any pending, threatened, or recently field lawsuit, claims, judgements, or tax liens against the business or any owner?
No
Yes
Has the business filed for bankruptcy?
No
Yes
Date Filed for Bankruptcy
MM slash DD slash YYYY
Are all tax payments current?
No
Yes
Do you have any existing debt, cash advances, or factoring?
No
Yes
Are all payments current?
No
Yes
Number of Debts, Cash Advances, or Factors
Select One
1
2
3
4
5
Creditor 1
Creditor 1
Creditor 1 Type of Debt
Creditor 1 Original Loan Amount
Creditor 1 Current Balance
Creditor 1 Origination Date
MM slash DD slash YYYY
Creditor 1 Contact
Creditor 1 Telephone
Creditor 2
Creditor 2
Creditor 2 Type of Debt
Creditor 2 Original Loan Amount
Creditor 2 Current Balance
Creditor 2 Origination Date
MM slash DD slash YYYY
Creditor 2 Contact
Creditor 2 Telephone
Creditor 3
Creditor 3
Creditor 3 Type of Debt
Creditor 3 Original Loan Amount
Creditor 3 Current Balance
Creditor 3 Origination Date
MM slash DD slash YYYY
Creditor 3 Contact
Creditor 3 Telephone
Creditor 4
Creditor 4
Creditor 4 Type of Debt
Creditor 4 Original Loan Amount
Creditor 4 Current Balance
Creditor 4 Origination Date
MM slash DD slash YYYY
Creditor 4 Contact
Creditor 4 Telephone
Creditor 5
Creditor 5
Creditor 5 Type of Debt
Creditor 5 Original Loan Amount
Creditor 5 Current Balance
Creditor 5 Origination Date
MM slash DD slash YYYY
Creditor 5 Contact
Creditor 5 Telephone
Step 5: Authorization
LQD Application Authorization
*
I Agree
By checking the "I Agree" box, the Company and each Owner hereby (i) represent that all of the above information is true and correct, and understand that making false statements constitutes fraud, (ii) authorize LQD Financial Corp. or its agents, (“LQD”), to investigate the financial responsibility and credit worthiness of the Company and each Owner, including, without limitation, authorization to conduct credit checks and/or background checks, and to pull each Owner's credit report or reports, (iv) to update the Company's credit profile from time to time in the future as LQD deems appropriate, and (v) to perform full tax and background checks on the Company and each Owner for the purpose of evaluating the creditworthiness of the Company.
If we take adverse action on your application for credit, you have the right to a statement of specific reasons as to why we took such adverse action if you request the statement within 60 days of our notification. You may contact notices@lqdfinance.com to obtain the statement of reasons. The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.
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