Pre-Application (please enter all fields. Someone will contact you to go over funding options with our company within 24 hours) * Company Name:   * * Contact (Full) Name:  * *  Address 1: *     Address 2:   *  City * *  State:   Select One.. Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming* *  Zip Code:   ** * Phone Number 1:   **Ext: *    Phone Number 2:   *  Ext: *    Fax Number:   *    Best time to contact you:   *  E-mail Address:   ** * Operating Since:   * [mm/yyyy] * Type of Business:   Select One.. Accounting (CPA) Aerospace Agricultural Aircraft Apparel Architect Attorney Automotive Parts Automotive Service Beverage Bio-Tech Chiropractor Computer Hardware Computer Software Construction Consulting Consumer Products Couriers/Messengers Defense Dental Technology Dentist Distribution Education Related Electronics Energy Entertainment Environmental Existing Technology Federal Government Film, Play, Video Financial Services Fitness Food Service Forestry and Fishing Funeral Home Gaming Garment Gasoline Station Health Products Healthcare Hi-Technology Import/Export Industrial Products Insurance Internet/Online Services Legal Profession Lodging Manufacturing Marine Media Production Medical ("ologists") Medical (licensed) Medical (therapists) Medical Technology Mobile Home Parks Mortician Municipal Natural resources New Technology Optometry Pharmacist Pharmaceuticals Piece Goods Printing Psychologists Publishing Real Estate Related Resorts Restaurant Retail Security Semi-Conductors Service Related Space Technology Staffing Telecommunications Textiles Titled Vehicles Transportation Trucking Veterinary Technology Veterinarian Warehousing/Storage Waste or Recycling Wholesale* * Monthly Gross Sales:   Select One.. 0 - $2,000 $2,001 - $10,000 $10,001 - $20,000 $20,001 - $30,000 $30,001 - $40,000 $40,001 - $50,000 $50,001 - $60,000 $60,001 - $70,000 $70,001 - $80,000 $80,001 - $90,000 $90,001 - $100,000 $100,000 - $200,000 $200,000+*   * Monthly Visa/Mastercard Sales:   Select One.. 0 - $2,000 $2,001 - $10,000 $10,001 - $20,000 $20,001 - $30,000 $30,001 - $40,000 $40,001 - $50,000 $50,001 - $60,000 $60,001 - $70,000 $70,001 - $80,000 $80,001 - $90,000 $90,001 - $100,000 $100,000 - $200,000 $200,000+ * How did you hear about us?   Select One.. 2000smart.com 4smallbusiness AOL BusinessFinance.com Current Customer Current Prospect Lendersinteractive.com Mag/Newspaper ad Moneyloans4U.com Netscape Search Other Radio ad Search Engine Trade Show/Conference TV ad*    If you have already spoken with one of our Sales Representatives, please enter their name:     Additional Comments:     Ex:How much funding does your business need?