Principal 1 Owner's Information:

Your First Name Your Last Name Home Address City
State
Zip
Social Security #
Birth Date
/ /
Phone # Cell Phone # Email Address Occupation Employer's Name Employer's Phone # Employer's Address Employer's City
State
Zip

Principal 2:

First Name Last Name Home Address City
State
Zip
Social Security #
Birth Date
/ /
Phone # Cell Phone # Email Address Occupation Employer's Name Employer's Phone # Employer's Address Employer's City
State
Zip

Financing Needs:

Equipment Type Model # Euipment is
Equipment Cost Wood-Mizer Consultant Wood-Mizer Location

Company Information:

Company Name Contact/Title Address City
State
Zip
Business Phone # Fax # Federal Tax ID Prior Year Gross Revenue Company Type/Industry Time in Business # Of Employees Time in Business Under Current Ownership Business Type
Where will Equipment be Located?

Bank & Trade References:

Bank Reference Name Bank Account # Bank Phone # Bank Contact Trade Reference Name Trade Reference Account # Trade Reference Phone # Trade Reference Contact
There is no charge to apply. A $60 loan processing fee will be included if the loan is finalized.
I verify that all information is correct and give permission for Wood-Mizer to do a credit check and process this application.*


AUTHORIZATIONS: Delivery of this application bearing a facsimile signature(s) shall have the same force and effect as if the application bore an inked original signature(s). The Company/Merchant and Owner(s)/Principal(s) identified above (individually, an "Applicant") each represents, acknowledges and agrees that (1) All information and documents provided to Direct Capital Corporation ("DCC") and Wood-Mizer, LLC (WM) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify DCC of any change in such information or financial condition, (3) Applicant authorizes DCC to disclose all information and documents that DCC may obtain including credit reports to other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial loans and/or Merchant Cash Advance transactions or other working capital products, including without limitation the application therefor (collectively, "Transactions") and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) each Assignee will rely upon the accuracy and completeness of such information and documents, (5) DCC, Assignees, and each of their representatives, successors, and assigns and designees (collectively, "Recipients") are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of information and (7) each Owner/Principal represents that he or she is authorized to, and does, sign this form on behalf of Merchant/Company (i.e., as well as in such Owner/Principal’s individual capacity). Application acknowledges that, based upon such information and other factors which may apply, a Recipient, in its sole discretion, may either approve or decline a proposed Transaction. By signing above, Applicant agrees to receive communications from Recipients via the email address(s) and/or fax number(s) provided above. Any applicant that provides a mobile device number expressly agrees to receive prerecorded messages and/or text messages at the number form Recipients or their agents, including with the use of an automatic dialer (autodialer). Standard text messaging rates apply.