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Application Submitted By

Please select the option that best describes who you are representing when completing this application: *

Applicant - You are the person or business applying for financing.
Lender – You are a lender submitting details on behalf of the applicant.
Referral Partner – You are a referral partner submitting on behalf of your client.
Vendor - You are a vendor submitting on behalf of your customer.
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Personal Information:

First Name *

Middle Name *

Last Name *

Date of birth *

Email *

Phone *

Mobile Phone *

Address

Street Address

City

State

Country

Afghanistan
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Virgin Islands, U.S.
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Postal code

Personal credit score?

Excellent (720+)
Good (680 - 719)
Fair (640 - 679)
Poor (639 or less)
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Loan Information:

Loan Type *

Select Loan Type

Working Capital
Equipment Finance Under $250k
Equipment Finance Over $250k
Other
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How much do you need? *

$10,000 - $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $750,000
$750,000+
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Secure Indentification Details:

What Is your Social Security Number (SSC)?

What is Your Employer Identification Number (EIN)?

Business Information:

Business Name *

Phone (Business) *

Email (Business) *

Street Address (Business) *

City (Business) *

State (Business) *

Postal Code (Business) *

Country (Business) *

Job Title *

Number of Employees? *

0-5
5-10
10-20
20-50
50-100
100+
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Annual Income *

Date Business Started *

Date You Became Business Owner Of This Location *

Legal Structure (CORP, LLC, SOLE PROP) *

DBA (Doing Business As)

FED# *

Industry *

Website *

Do any of the following apply to you or your business? *

Court Judgment

Lien

Bankruptcy

Collection Accounts

Defaulted Loans

None of the above

Other (please explain)

If you selected any of the above, please provide details

Equipment Details:

Purpose / Use of Equipment *

Type of Equipment to be Purchased *

Estimated Equipment Cost *

Are You Currently Renting Similar Equipment

No.
Yes. Only Recently
Yes. Equipment Been on Lot for Over 20 Days
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Expected Revenue from Equipment

Rental Monthly Cost

If yes, please give details on the rental start date and end date

Ownership Information:

Owner 1

Name & Title (Owner 1) *

Address (Owner 1) *

DOB (Owner 1) *

Phone (Owner 1) *

Email (Owner 1) *

% Of Ownership (Owner 1) *

Social Security Number (Owner 1) *

Owner 2

Name & Title (Owner 2)

Address (Owner 2)

DOB (Owner 2)

Phone (Owner 2)

Email (Owner 2)

% Of Ownership (Owner 2)

Social Security Number (Owner 2)

Vendor Details:
IF APPLICABLE

Vendor Company Name

Vendor Contact Name

Vendor Phone Number

Vendor Email

Documents Required:

YOUR CHECKLIST

Working Capital - Required Documents List

Click dropdown to view the list of documents required for your Working Capital loan

Driver's License: A clear copy of a valid driver's license for identification purposes.
Voided Check: A voided check from your business account to confirm banking details.
Bank Statements: Recent bank statements from the last three months for your business account.
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EF Under $250K - Required Documents List

Click dropdown to view the list of Documents Required for your EF Under $250K

Driver's License: A clear copy of a valid driver's license for identification purposes.
Voided Check: A voided check from your business account to confirm banking details.
Bank Statements: Recent bank statements from the last three months for your business account.
Invoice: Showing all items that are to be funded.
Title (if applicable).
Proof of Ownership: Secretary of State, K1 or Articles of Organization.
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EF Over $250K - Required Documents List

Click dropdown to view the list of documents required for your EF Over $250K

Driver's License: A clear copy of a valid driver's license for identification purposes.
Voided Check: A voided check from your business account to confirm banking details.
Bank Statements: Recent bank statements from the last three months for your business account.
Invoice: Showing all items that are to be funded.
Title (if applicable).
Proof of Ownership: Secretary of State, K1 or Articles of Organization.
2 years tax returns all pages and schedules for both business and personal on all owners.
Profit and Loss.
Balance Sheet.
Interim Statement.
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Other

Click dropdown to view the list of standard documents required.

Driver’s License – Clear copy of a valid ID
Voided Check – From your business account
Bank Statements – Most recent 3 months (business account)
Invoice – For any equipment being funded
Title – If applicable
Proof of Ownership – e.g. Secretary of State document, K-1, or Articles of Organization
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Upload Documents to Secure File *

Signature, Authorization & Consent:

Full Name (Acts as Signature) *

Signature for Loan *

Clear

Checkbox Required

By checking the box and signing above, I confirm that the information provided is true and accurate, and I authorize Coastal Kapital, LLC to use the details supplied, including bank information, solely for the purpose of establishing and maintaining our vendor relationship and processing payments. I understand this information will be stored securely and accessed only by authorized personnel.

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