Application – Poseidon Financial Network

PFN Application

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

First name:*

Last name:*

Phone number:*

Amount Requested:*

Use of Funds:*

Company Name:*

DBA:

Physical Address:*

City:*

State:*

ZIP:*

Is mailing address same as physical address?*

Yes

Mailing Address:*

City:*

State:*

ZIP:*

When was the business founded?*

Length of Ownership?*

State of Incorporation?*

FEIN / Tax ID:*

Entity Type:*

Industry/Service Provided:*

Annual Revenue:*

Do you currently have any financing/loans?*

Yes

What is your outstanding balance?*

Are you the sole owner?

Yes

Owner's First Name*

Owner's Last Name*

Home Address:*

City:*

State:*

ZIP code:*

Cell phone number:*

Email:*

Date of Birth:*

SSN:*

Ownership %?*

FICO Score:*

2nd Owner's First Name*

2nd Owner's Last Name*

2nd Owner's Home Address:*

2nd Owner's City:*

2nd Owner's State:*

2nd Owner's ZIP code:*

2nd Owner's Cell phone number:*

2nd Owner's Date of Birth:*

2nd Owner's SSN:*

2nd Owner's Ownership %?*

2nd Owner's FICO Score:*

Signature*

Date*

2nd Owner's Signature*

Date*