Please fill out the Information below to Apply for a U.I.G. Loan Securely. Thank You!.

Business Information
Business Name:
Address:
     Street Address:
     City:
     State:
     Zip:
Phone: ( ) -
Type of Business:
Age of Business:
Federal Tax ID:
Location of Equipment (address):
Ownership Information
First Principals Complete Name:
Title:
% Ownership:
Social Security Number :
Drivers License Number:
Home Ownership: (rent or own)
Address:
     Street Address:
     City:
     State:
     Zip:
Phone: ( ) -
Second Principals Complete Name:
Title:
% Ownership:
Social Security Number :
Drivers License Number:
Home Ownership: (rent or own)
Address:
     Street Address:
     City:
     State:
     Zip:
Phone: ( ) -
Third Principals Complete Name:
Title:
% Ownership:
Social Security Number :
Drivers License Number:
Home Ownership: (rent or own)
Address:
     Street Address:
     City:
     State:
     Zip:
Phone: ( ) -
Bank Information
First Bank:
Contact:
Account under name of:
Checking Account #:
Orig. Balance :
Current Balance :
Fax: ( ) -
Phone: ( ) -
Second Bank:
Contact:
Account under name of:
Checking Account #:
Orig. Balance :
Current Balance :
Fax: ( ) -
Phone: ( ) -
Third Bank:
Contact:
Account under name of:
Checking Account #:
Orig. Balance :
Current Balance :
Fax: ( ) -
Phone: ( ) -
Trades
Company Name
Account #
Telephone
Contact Person
Equipment Information
Vendor:
Contact:
Address:
     Street Address:
     City:
     State:
     Zip:
Phone: ( ) -
Equipment to be lease:
Cost of Equipment:
Terms of Lease:
Rate / Monthly Payment:
Deposit Received:

By clicking on Apply for U.I.G. Loan, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction to U.I.G FACTOR CORP financial or its assignee ( and any assignee or potential assignee there of) authorized review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A digital copy of this authorization shall be valid as the original. By clicking below, I/we affirm my/our identity as the respective individual/s identified in the above application.