Loan Inquiry

Financing Request

Please note: Accompany Capital can only provide loans for businesses in New York City's five boroughs.

Financing Amount Requested

Purpose of Loan

Have you received a loan from Accompany Capital in the past?

YesNo

Other Loan Purpose

Please describe how the loans funds will be used:

Please note: Some loan requests may require additional guarantors.

How did you hear about Accompany Capital?

Other way of hearing about Accompany Capital

Please provide name of referral, such as a specific person or business

Personal Information

First Name

Last Name

E-Mail Address

Phone Number

Birthdate

Gender

Present Street Address

City

State

Zip Code

What is your preferred language?

Present Gross Household Income - Monthly

Please include income of any kind and from sources including your spouse if available.

Spousal Income (if any) - Monthly

Monthly Mortgage/Rent

Estimated Personal Assets (Total)

Include cash, stock, retirement/pension, real estate, and other business assets.

Estimated Personal Liabilities (Total)

Include all loans, notes payable, mortgage, credit card or other personal debt, and any tax liabilities.

Do you have an additional source of income or financial support outside the business?

Other Income Type

Other Income Amount - Monthly

Business Information

Legal Business Name

D.B.A. (Doing Business As) Name (if applicable)

Industry

Business Description

Business Street Address

City

State

Zip Code

Borough

Business location must be within NYC's 5 boroughs. If your business is not located in one of the 5 boroughs, please do not proceed.

Phone Number

If your business does not have a phone number, please list your personal phone number again.

E-Mail Address

Business Legal Structure

Date Business Founded

Years in Business

Employer Identification Number (EIN)

Enter 9 numbers with no dashes

Monthly Sales

Net Income Last Year

Projected Gross Revenue this year

Revenue Last Year

Is your business profitable?

YesNo

How much have you invested in the business?

Do you have any existing business debt?

YesNo

Credit Request Authorization

I authorize Accompany Capital or its authorized agents to obtain Consumer Credit report(s) or information on the person(s) identified in this request and during the outstanding term of the loan if approved.

Please confirm that you have read and agree to credit authorization by entering your FIRST and LAST name.

Any loan application that results from this inquiry will not be considered complete without a non-refundable application fee of $25.00 for loans up to $3,000 and $50 for loans over $3,000, plus $15.00 per additional credit report for each guarantor/co-signer.

Financing provided by Accompany Capital's Micro Loan Fund requires a 1% closing fee and must be repaid on a monthly basis with a fixed interest rate of 8%.

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging. By submitting this application, you agree to our communications as outlined in our Privacy Policy. Please review it to understand how we handle and protect your information.

Marketing Opt-In

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Hidden Fields

Loan Staff Contact: User ID

Contact Information