Application

United Capital Funding Quote

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Welcome to Gulf Coast Bank & Trust Co.'s asset based lending & factoring division. You are about to complete our application for approval. The approval process will take 24 hours. Make sure you don't miss any questions or omit any information but please don't let any one question deter you from applying. If a question we are asking doesn't apply to your company, simply skip that question and move on. The more complete your application, the better chance you will be approved for a lower rate. Should you have any questions regarding this application, please contact our main line at 866-577-8867 or email us at gcbcinfo@gulfbank.com. We look forward to working with you.

  • Form Nav Pic General
    Information
  • Form Nav Pic Financial
    Information
  • Form Nav Pic Ownership
    Information
  • Form Nav Pic Officer
    Information





























For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and ManagersManager

Sole Proprietor - Owner, Corporate SecretaryN/A - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




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For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




%










For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




%










For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




%










For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




%










For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers




%










General Information

Business Name:

Business Phone:

Business Street Address:

City:

State/Province:

Zip Code:

Business Mailing Address:

City:

Zip Code:

State/Province:

Organization Type:

How many Owners:

General Description:

Date Business Established:

State of Organization/State Entity Formed:

Financial Information

Federal E.I.N./T.I.N:

Are you currently factoring?:

If so, with whom?:

Does the company have any IRS liens or past due IRS obligations?:

If yes, is there a payment plan or subordination currently in place?:

Does the company accept credit card payments from customers?:

Annual Sales/Revenue:

Facility Size:

Average Number of Invoices Per Month:

Average Invoice Size:

Projected Monthly Funding Volume:

Ownership Information

Owner 1

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 2

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 3

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 4

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 5

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 6

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Financial Information





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