Application

Please complete all fields. Thank you!

Company/Individual Name:

Company/Individual Address:

Tax ID Number:

Website:

Phone

Fax:

Email:

Professional Relationships

Bank Name:

Banker Name:

CPA Firm:

CPA Name:

Attorney Firm:

Attorney Name:

Company Ownership (Must Total 100%)

Name1:

Address:

Social Security Number:

Date of Birth:

Ownership %:

Name2:

Address:

Social Security Number:

Date of Birth:

Ownership %:

Name3:

Address:

Social Security Number:

Date of Birth:

Ownership %:

Name4:

Address:

Social Security Number:

Date of Birth:

Ownership %:

Additional Company Information

Number of Employees:

Industry:

Annual Revenue

Year Company Formed:

For requests greater than $50,000, be prepared to provide both company and personal financial statements and tax returns.

How to expedite your application and transaction?

Have your assumed name certificate (if sole proprietor) or entity documents available and ready to submit. For all signers and guarantors, have a color copy of your drivers license ready to submit. Have your insurance provider on notice to provide an insurance binder for your asset purchase reflecting 'TransCon Capital, LLC and assigns' as loss payee. Some or all of that information can be uploaded below.

Optional Document Submittal:

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Electronic Signature and Submission: This application has been prepared to the best of my knowledge and I certify that the information provided herein is true and correct. I authorize TransCon Capital, LLC and its assigns, to take all necessary action to verify the creditworthiness of the company and principals listed herein, including but not limited to, obtaining third party credit reports on the company and principals referenced herein.

Submitted By:

Title:

Date: