{"id":4421,"date":"2015-09-03T19:19:10","date_gmt":"2015-09-03T23:19:10","guid":{"rendered":"https:\/\/barthelemycc.com\/?page_id=4421"},"modified":"2017-11-10T20:20:59","modified_gmt":"2017-11-11T01:20:59","slug":"personal-loan-application","status":"publish","type":"page","link":"https:\/\/barthelemycc.com\/?page_id=4421","title":{"rendered":"Personal Loan Application"},"content":{"rendered":"
\n\t \t
Personal Loan Application<\/h3><\/div>
Please Note: <\/label>The asterisk* indicates a required field. What does not apply to you, please type \"n\/a\" or leave blank. This application is protected and encrypted by a secure server. All of your information is private and confidential.<\/li>
Loan Amount <\/label>
<\/li><\/ul> <\/fieldset>
Personal Information<\/h3><\/div>
First Name
*<\/span><\/label>
<\/li>
Middle Name or Initial <\/label>
<\/li>
Last Name
*<\/span><\/label>
<\/li>
Address
*<\/span><\/label>
Street Address<\/label><\/span>
Apt, Suite, Bldg. (optional)<\/label><\/span>
City<\/label><\/span>
State \/ Province \/ Region<\/label><\/span>
Postal \/ Zip Code<\/label><\/span>
<\/option>
Afghanistan<\/option>
Albania<\/option>
Algeria<\/option>
Andorra<\/option>
Angola<\/option>
Antigua and Barbuda<\/option>
Argentina<\/option>
Armenia<\/option>
Australia<\/option>
Austria<\/option>
Azerbaijan<\/option>
Bahamas<\/option>
Bahrain<\/option>
Bangladesh<\/option>
Barbados<\/option>
Belarus<\/option>
Belgium<\/option>
Belize<\/option>
Benin<\/option>
Bhutan<\/option>
Bolivia<\/option>
Bosnia and Herzegovina<\/option>
Botswana<\/option>
Brazil<\/option>
Brunei<\/option>
Bulgaria<\/option>
Burkina Faso<\/option>
Burundi<\/option>
Cambodia<\/option>
Cameroon<\/option>
Canada<\/option>
Cape Verde<\/option>
Central African Republic<\/option>
Chad<\/option>
Chile<\/option>
China<\/option>
Colombia<\/option>
Comoros<\/option>
Congo (Brazzaville)<\/option>
Congo<\/option>
Costa Rica<\/option>
Cote d\\'Ivoire<\/option>
Croatia<\/option>
Cuba<\/option>
Cyprus<\/option>
Czech Republic<\/option>
Denmark<\/option>
Djibouti<\/option>
Dominica<\/option>
Dominican Republic<\/option>
East Timor (Timor Timur)<\/option>
Ecuador<\/option>
Egypt<\/option>
El Salvador<\/option>
Equatorial Guinea<\/option>
Eritrea<\/option>
Estonia<\/option>
Ethiopia<\/option>
Fiji<\/option>
Finland<\/option>
France<\/option>
Gabon<\/option>
Gambia, The<\/option>
Georgia<\/option>
Germany<\/option>
Ghana<\/option>
Greece<\/option>
Grenada<\/option>
Guatemala<\/option>
Guinea<\/option>
Guinea-Bissau<\/option>
Guyana<\/option>
Haiti<\/option>
Honduras<\/option>
Hungary<\/option>
Iceland<\/option>
India<\/option>
Indonesia<\/option>
Iran<\/option>
Iraq<\/option>
Ireland<\/option>
Israel<\/option>
Italy<\/option>
Jamaica<\/option>
Japan<\/option>
Jordan<\/option>
Kazakhstan<\/option>
Kenya<\/option>
Kiribati<\/option>
Korea, North<\/option>
Korea, South<\/option>
Kuwait<\/option>
Kyrgyzstan<\/option>
Laos<\/option>
Latvia<\/option>
Lebanon<\/option>
Lesotho<\/option>
Liberia<\/option>
Libya<\/option>
Liechtenstein<\/option>
Lithuania<\/option>
Luxembourg<\/option>
Macedonia<\/option>
Madagascar<\/option>
Malawi<\/option>
Malaysia<\/option>
Maldives<\/option>
Mali<\/option>
Malta<\/option>
Marshall Islands<\/option>
Mauritania<\/option>
Mauritius<\/option>
Mexico<\/option>
Micronesia<\/option>
Moldova<\/option>
Monaco<\/option>
Mongolia<\/option>
Montenegro<\/option>
Morocco<\/option>
Mozambique<\/option>
Myanmar<\/option>
Namibia<\/option>
Nauru<\/option>
Nepal<\/option>
Netherlands<\/option>
New Zealand<\/option>
Nicaragua<\/option>
Niger<\/option>
Nigeria<\/option>
Norway<\/option>
Oman<\/option>
Pakistan<\/option>
Palestinian Territory<\/option>
Palau<\/option>
Panama<\/option>
Papua New Guinea<\/option>
Paraguay<\/option>
Peru<\/option>
Philippines<\/option>
Poland<\/option>
Portugal<\/option>
Qatar<\/option>
Romania<\/option>
Russia<\/option>
Rwanda<\/option>
Saint Kitts and Nevis<\/option>
Saint Lucia<\/option>
Saint Vincent<\/option>
Samoa<\/option>
San Marino<\/option>
Sao Tome and Principe<\/option>
Saudi Arabia<\/option>
Senegal<\/option>
Serbia<\/option>
Seychelles<\/option>
Sierra Leone<\/option>
Singapore<\/option>
Slovakia<\/option>
Slovenia<\/option>
Solomon Islands<\/option>
Somalia<\/option>
South Africa<\/option>
Spain<\/option>
Sri Lanka<\/option>
Sudan<\/option>
Suriname<\/option>
Swaziland<\/option>
Sweden<\/option>
Switzerland<\/option>
Syria<\/option>
Taiwan<\/option>
Tajikistan<\/option>
Tanzania<\/option>
Thailand<\/option>
Togo<\/option>
Tonga<\/option>
Trinidad and Tobago<\/option>
Tunisia<\/option>
Turkey<\/option>
Turkmenistan<\/option>
Tuvalu<\/option>
Uganda<\/option>
Ukraine<\/option>
United Arab Emirates<\/option>
United Kingdom<\/option>
United States of America<\/option>
Uruguay<\/option>
Uzbekistan<\/option>
Vanuatu<\/option>
Vatican City<\/option>
Venezuela<\/option>
Vietnam<\/option>
Western Sahara<\/option>
Western Samoa<\/option>
Yemen<\/option>
Zambia<\/option>
Zimbabwe<\/option><\/select>
Country<\/label><\/span><\/div><\/li>
Email Address
*<\/span><\/label>
<\/li>
Contact Phone
*<\/span><\/label>
<\/li>
Work Phone
*<\/span><\/label>
<\/li>
Date of Birth
*<\/span><\/label>
<\/li>
Social Security Number
*<\/span><\/label>
Please enter your valid social security number.<\/label><\/span><\/li>
Source of Income
*<\/span><\/label>
Self Employed<\/label><\/span>
Employed<\/label><\/span>
Other<\/label><\/span>
<\/div><\/div><\/li>
If Other, Please list source of income <\/label>
<\/li>
Annual Gross Income
*<\/span><\/label>
<\/li>
How Often Paid?
*<\/span><\/label>
Weekly<\/option>
Bi-Weekly<\/option>
Monthly<\/option>
Annually<\/option>
Other<\/option><\/select><\/li>
Name of Employer <\/label>
<\/li>
Employer or Business Address
*<\/span><\/label>
Street Address<\/label><\/span>
Apt, Suite, Bldg. (optional)<\/label><\/span>
City<\/label><\/span>
State \/ Province \/ Region<\/label><\/span>
Postal \/ Zip Code<\/label><\/span>
<\/option>
Afghanistan<\/option>
Albania<\/option>
Algeria<\/option>
Andorra<\/option>
Angola<\/option>
Antigua and Barbuda<\/option>
Argentina<\/option>
Armenia<\/option>
Australia<\/option>
Austria<\/option>
Azerbaijan<\/option>
Bahamas<\/option>
Bahrain<\/option>
Bangladesh<\/option>
Barbados<\/option>
Belarus<\/option>
Belgium<\/option>
Belize<\/option>
Benin<\/option>
Bhutan<\/option>
Bolivia<\/option>
Bosnia and Herzegovina<\/option>
Botswana<\/option>
Brazil<\/option>
Brunei<\/option>
Bulgaria<\/option>
Burkina Faso<\/option>
Burundi<\/option>
Cambodia<\/option>
Cameroon<\/option>
Canada<\/option>
Cape Verde<\/option>
Central African Republic<\/option>
Chad<\/option>
Chile<\/option>
China<\/option>
Colombia<\/option>
Comoros<\/option>
Congo (Brazzaville)<\/option>
Congo<\/option>
Costa Rica<\/option>
Cote d\\'Ivoire<\/option>
Croatia<\/option>
Cuba<\/option>
Cyprus<\/option>
Czech Republic<\/option>
Denmark<\/option>
Djibouti<\/option>
Dominica<\/option>
Dominican Republic<\/option>
East Timor (Timor Timur)<\/option>
Ecuador<\/option>
Egypt<\/option>
El Salvador<\/option>
Equatorial Guinea<\/option>
Eritrea<\/option>
Estonia<\/option>
Ethiopia<\/option>
Fiji<\/option>
Finland<\/option>
France<\/option>
Gabon<\/option>
Gambia, The<\/option>
Georgia<\/option>
Germany<\/option>
Ghana<\/option>
Greece<\/option>
Grenada<\/option>
Guatemala<\/option>
Guinea<\/option>
Guinea-Bissau<\/option>
Guyana<\/option>
Haiti<\/option>
Honduras<\/option>
Hungary<\/option>
Iceland<\/option>
India<\/option>
Indonesia<\/option>
Iran<\/option>
Iraq<\/option>
Ireland<\/option>
Israel<\/option>
Italy<\/option>
Jamaica<\/option>
Japan<\/option>
Jordan<\/option>
Kazakhstan<\/option>
Kenya<\/option>
Kiribati<\/option>
Korea, North<\/option>
Korea, South<\/option>
Kuwait<\/option>
Kyrgyzstan<\/option>
Laos<\/option>
Latvia<\/option>
Lebanon<\/option>
Lesotho<\/option>
Liberia<\/option>
Libya<\/option>
Liechtenstein<\/option>
Lithuania<\/option>
Luxembourg<\/option>
Macedonia<\/option>
Madagascar<\/option>
Malawi<\/option>
Malaysia<\/option>
Maldives<\/option>
Mali<\/option>
Malta<\/option>
Marshall Islands<\/option>
Mauritania<\/option>
Mauritius<\/option>
Mexico<\/option>
Micronesia<\/option>
Moldova<\/option>
Monaco<\/option>
Mongolia<\/option>
Montenegro<\/option>
Morocco<\/option>
Mozambique<\/option>
Myanmar<\/option>
Namibia<\/option>
Nauru<\/option>
Nepal<\/option>
Netherlands<\/option>
New Zealand<\/option>
Nicaragua<\/option>
Niger<\/option>
Nigeria<\/option>
Norway<\/option>
Oman<\/option>
Pakistan<\/option>
Palestinian Territory<\/option>
Palau<\/option>
Panama<\/option>
Papua New Guinea<\/option>
Paraguay<\/option>
Peru<\/option>
Philippines<\/option>
Poland<\/option>
Portugal<\/option>
Qatar<\/option>
Romania<\/option>
Russia<\/option>
Rwanda<\/option>
Saint Kitts and Nevis<\/option>
Saint Lucia<\/option>
Saint Vincent<\/option>
Samoa<\/option>
San Marino<\/option>
Sao Tome and Principe<\/option>
Saudi Arabia<\/option>
Senegal<\/option>
Serbia<\/option>
Seychelles<\/option>
Sierra Leone<\/option>
Singapore<\/option>
Slovakia<\/option>
Slovenia<\/option>
Solomon Islands<\/option>
Somalia<\/option>
South Africa<\/option>
Spain<\/option>
Sri Lanka<\/option>
Sudan<\/option>
Suriname<\/option>
Swaziland<\/option>
Sweden<\/option>
Switzerland<\/option>
Syria<\/option>
Taiwan<\/option>
Tajikistan<\/option>
Tanzania<\/option>
Thailand<\/option>
Togo<\/option>
Tonga<\/option>
Trinidad and Tobago<\/option>
Tunisia<\/option>
Turkey<\/option>
Turkmenistan<\/option>
Tuvalu<\/option>
Uganda<\/option>
Ukraine<\/option>
United Arab Emirates<\/option>
United Kingdom<\/option>
United States of America<\/option>
Uruguay<\/option>
Uzbekistan<\/option>
Vanuatu<\/option>
Vatican City<\/option>
Venezuela<\/option>
Vietnam<\/option>
Western Sahara<\/option>
Western Samoa<\/option>
Yemen<\/option>
Zambia<\/option>
Zimbabwe<\/option><\/select>
Country<\/label><\/span><\/div><\/li>
Employer Phone <\/label>
<\/li>
Date You Started Working with this Employer
*<\/span><\/label>
<\/li>
May we contact your Employer to verify? <\/label>
Yes<\/label><\/span>
No<\/label><\/span>
<\/div><\/div><\/li>
Do You Rent Or Own Your Home?
*<\/span><\/label>
Rent<\/label><\/span>
Own<\/label><\/span>
Other<\/label><\/span>
<\/div><\/div><\/li>
How Much Is Your Rent or Mortgage per Month? <\/label>
<\/li><\/ul> <\/fieldset>
Personal Banking Information<\/h3><\/div>
Name of Banking Institution <\/label>
<\/li>
Bank Address <\/label>
Street Address<\/label><\/span>
Apt, Suite, Bldg. (optional)<\/label><\/span>
City<\/label><\/span>
State \/ Province \/ Region<\/label><\/span>
Postal \/ Zip Code<\/label><\/span>
<\/option>
Afghanistan<\/option>
Albania<\/option>
Algeria<\/option>
Andorra<\/option>
Angola<\/option>
Antigua and Barbuda<\/option>
Argentina<\/option>
Armenia<\/option>
Australia<\/option>
Austria<\/option>
Azerbaijan<\/option>
Bahamas<\/option>
Bahrain<\/option>
Bangladesh<\/option>
Barbados<\/option>
Belarus<\/option>
Belgium<\/option>
Belize<\/option>
Benin<\/option>
Bhutan<\/option>
Bolivia<\/option>
Bosnia and Herzegovina<\/option>
Botswana<\/option>
Brazil<\/option>
Brunei<\/option>
Bulgaria<\/option>
Burkina Faso<\/option>
Burundi<\/option>
Cambodia<\/option>
Cameroon<\/option>
Canada<\/option>
Cape Verde<\/option>
Central African Republic<\/option>
Chad<\/option>
Chile<\/option>
China<\/option>
Colombia<\/option>
Comoros<\/option>
Congo (Brazzaville)<\/option>
Congo<\/option>
Costa Rica<\/option>
Cote d\\'Ivoire<\/option>
Croatia<\/option>
Cuba<\/option>
Cyprus<\/option>
Czech Republic<\/option>
Denmark<\/option>
Djibouti<\/option>
Dominica<\/option>
Dominican Republic<\/option>
East Timor (Timor Timur)<\/option>
Ecuador<\/option>
Egypt<\/option>
El Salvador<\/option>
Equatorial Guinea<\/option>
Eritrea<\/option>
Estonia<\/option>
Ethiopia<\/option>
Fiji<\/option>
Finland<\/option>
France<\/option>
Gabon<\/option>
Gambia, The<\/option>
Georgia<\/option>
Germany<\/option>
Ghana<\/option>
Greece<\/option>
Grenada<\/option>
Guatemala<\/option>
Guinea<\/option>
Guinea-Bissau<\/option>
Guyana<\/option>
Haiti<\/option>
Honduras<\/option>
Hungary<\/option>
Iceland<\/option>
India<\/option>
Indonesia<\/option>
Iran<\/option>
Iraq<\/option>
Ireland<\/option>
Israel<\/option>
Italy<\/option>
Jamaica<\/option>
Japan<\/option>
Jordan<\/option>
Kazakhstan<\/option>
Kenya<\/option>
Kiribati<\/option>
Korea, North<\/option>
Korea, South<\/option>
Kuwait<\/option>
Kyrgyzstan<\/option>
Laos<\/option>
Latvia<\/option>
Lebanon<\/option>
Lesotho<\/option>
Liberia<\/option>
Libya<\/option>
Liechtenstein<\/option>
Lithuania<\/option>
Luxembourg<\/option>
Macedonia<\/option>
Madagascar<\/option>
Malawi<\/option>
Malaysia<\/option>
Maldives<\/option>
Mali<\/option>
Malta<\/option>
Marshall Islands<\/option>
Mauritania<\/option>
Mauritius<\/option>
Mexico<\/option>
Micronesia<\/option>
Moldova<\/option>
Monaco<\/option>
Mongolia<\/option>
Montenegro<\/option>
Morocco<\/option>
Mozambique<\/option>
Myanmar<\/option>
Namibia<\/option>
Nauru<\/option>
Nepal<\/option>
Netherlands<\/option>
New Zealand<\/option>
Nicaragua<\/option>
Niger<\/option>
Nigeria<\/option>
Norway<\/option>
Oman<\/option>
Pakistan<\/option>
Palestinian Territory<\/option>
Palau<\/option>
Panama<\/option>
Papua New Guinea<\/option>
Paraguay<\/option>
Peru<\/option>
Philippines<\/option>
Poland<\/option>
Portugal<\/option>
Qatar<\/option>
Romania<\/option>
Russia<\/option>
Rwanda<\/option>
Saint Kitts and Nevis<\/option>
Saint Lucia<\/option>
Saint Vincent<\/option>
Samoa<\/option>
San Marino<\/option>
Sao Tome and Principe<\/option>
Saudi Arabia<\/option>
Senegal<\/option>
Serbia<\/option>
Seychelles<\/option>
Sierra Leone<\/option>
Singapore<\/option>
Slovakia<\/option>
Slovenia<\/option>
Solomon Islands<\/option>
Somalia<\/option>
South Africa<\/option>
Spain<\/option>
Sri Lanka<\/option>
Sudan<\/option>
Suriname<\/option>
Swaziland<\/option>
Sweden<\/option>
Switzerland<\/option>
Syria<\/option>
Taiwan<\/option>
Tajikistan<\/option>
Tanzania<\/option>
Thailand<\/option>
Togo<\/option>
Tonga<\/option>
Trinidad and Tobago<\/option>
Tunisia<\/option>
Turkey<\/option>
Turkmenistan<\/option>
Tuvalu<\/option>
Uganda<\/option>
Ukraine<\/option>
United Arab Emirates<\/option>
United Kingdom<\/option>
United States of America<\/option>
Uruguay<\/option>
Uzbekistan<\/option>
Vanuatu<\/option>
Vatican City<\/option>
Venezuela<\/option>
Vietnam<\/option>
Western Sahara<\/option>
Western Samoa<\/option>
Yemen<\/option>
Zambia<\/option>
Zimbabwe<\/option><\/select>
Country<\/label><\/span><\/div><\/li>
Bank Phone <\/label>
<\/li>
Type of Account (s) <\/label>
Checking<\/label><\/span>
Savings<\/label><\/span>
Other<\/label><\/span>
<\/div><\/div><\/li>
Account Number <\/label>
<\/li>
Please list any other assets here. <\/label>
<\/textarea><\/div><\/li><\/ul> <\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-4 business-information \" id=\"item-vfb-107\"><div class=\"vfb-legend\"><h3>Business Information<\/h3><\/div><ul class=\"vfb-section vfb-section-4\"><li class=\"vfb-item vfb-item-text \" id=\"item-vfb-106\"><label for=\"vfb-106\" class=\"vfb-desc\">Name of Business <\/label><input type=\"text\" name=\"vfb-106\" id=\"vfb-106\" value=\"\" class=\"vfb-text vfb-medium \" \/><\/li><li class=\"vfb-item vfb-item-address \" id=\"item-vfb-108\"><label class=\"vfb-desc\">Business Address <\/label><div><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-108[address]\" id=\"vfb-108-address\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-108-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-108[address-2]\" id=\"vfb-108-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-108-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-108[city]\" id=\"vfb-108-city\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-108-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-108[state]\" id=\"vfb-108-state\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-108-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-108[zip]\" id=\"vfb-108-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-108-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-108[country]\" class=\"vfb-select \" id=\"vfb-108-country\"><option value=\"\" selected='selected'><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palestinian Territory\">Palestinian Territory<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\">United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Western Samoa\">Western Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><label for=\"vfb-108-country\">Country<\/label><\/span><\/div><\/li><li class=\"vfb-item vfb-item-phone vfb-left-third\" id=\"item-vfb-109\"><label for=\"vfb-109\" class=\"vfb-desc\">Business Phone <\/label><input type=\"tel\" name=\"vfb-109\" id=\"vfb-109\" value=\"\" class=\"vfb-text vfb-medium phone \" \/><\/li><li class=\"vfb-item vfb-item-email vfb-middle-third\" id=\"item-vfb-118\"><label for=\"vfb-118\" class=\"vfb-desc\">Business Email <\/label><input type=\"email\" name=\"vfb-118\" id=\"vfb-118\" value=\"\" class=\"vfb-text vfb-medium email \" \/><\/li><li class=\"vfb-item vfb-item-url vfb-right-third\" id=\"item-vfb-119\"><label for=\"vfb-119\" class=\"vfb-desc\">Business Website <\/label><input type=\"url\" name=\"vfb-119\" id=\"vfb-119\" value=\"\" class=\"vfb-text vfb-medium url \" \/><\/li><li class=\"vfb-item vfb-item-text vfb-left-third\" id=\"item-vfb-110\"><label for=\"vfb-110\" class=\"vfb-desc\">Type of Business <\/label><input type=\"text\" name=\"vfb-110\" id=\"vfb-110\" value=\"\" class=\"vfb-text vfb-medium \" \/><\/li><li class=\"vfb-item vfb-item-date vfb-middle-third\" id=\"item-vfb-111\"><label for=\"vfb-111\" class=\"vfb-desc\">Date Business Started <\/label><input type=\"text\" name=\"vfb-111\" id=\"vfb-111\" value=\"\" class=\"vfb-text vfb-date-picker vfb-medium \" data-dp-dateFormat=\"mm\/dd\/yy\" \/><\/li><li class=\"vfb-item vfb-item-select vfb-right-third\" id=\"item-vfb-112\"><label for=\"vfb-112\" class=\"vfb-desc\">Business Structure <\/label><select name=\"vfb-112\" id=\"vfb-112\" class=\"vfb-select vfb-medium \"><option value=\"Sole Proprietorship\">Sole Proprietorship<\/option><option value=\"Corporation\">Corporation<\/option><option value=\"Limited Liability Corporation\">Limited Liability Corporation<\/option><option value=\"Non Profit\">Non Profit<\/option><option value=\"Partnership\">Partnership<\/option><option value=\"Not Started Yet\">Not Started Yet<\/option><\/select><\/li><li class=\"vfb-item vfb-item-text vfb-left-third\" id=\"item-vfb-134\"><label for=\"vfb-134\" class=\"vfb-desc\">Name of Principal or Authorized Officer of Business <\/label><input type=\"text\" name=\"vfb-134\" id=\"vfb-134\" value=\"\" class=\"vfb-text vfb-medium \" \/><\/li><li class=\"vfb-item vfb-item-number vfb-middle-third\" id=\"item-vfb-89\"><label for=\"vfb-89\" class=\"vfb-desc\">Number of Employees <\/label><input type=\"text\" name=\"vfb-89\" id=\"vfb-89\" value=\"\" class=\"vfb-text vfb-medium digits \" \/><\/li><li class=\"vfb-item vfb-item-radio vfb-right-third\" id=\"item-vfb-113\"><label class=\"vfb-desc\">Do you rent or own your business location? <\/label><div><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-113\" id=\"vfb-113-1\" value=\"Rent\" class=\"vfb-radio \" \/><label for=\"vfb-113-1\" class=\"vfb-choice\">Rent<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-113\" id=\"vfb-113-2\" value=\"Own\" class=\"vfb-radio \" \/><label for=\"vfb-113-2\" class=\"vfb-choice\">Own<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-113\" id=\"vfb-113-3\" value=\"Homebased\" class=\"vfb-radio \" \/><label for=\"vfb-113-3\" class=\"vfb-choice\">Homebased<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-113\" id=\"vfb-113-4\" value=\"Mobile\" class=\"vfb-radio \" \/><label for=\"vfb-113-4\" class=\"vfb-choice\">Mobile<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-number vfb-left-third\" id=\"item-vfb-114\"><label for=\"vfb-114\" class=\"vfb-desc\">Federal Tax ID# (EIN) <\/label><input type=\"text\" name=\"vfb-114\" id=\"vfb-114\" value=\"\" class=\"vfb-text vfb-medium digits \" \/><\/li><li class=\"vfb-item vfb-item-number vfb-middle-third\" id=\"item-vfb-116\"><label for=\"vfb-116\" class=\"vfb-desc\">Dun and Bradstreet Number <\/label><input type=\"text\" name=\"vfb-116\" id=\"vfb-116\" value=\"\" class=\"vfb-text vfb-medium digits \" \/><\/li><li class=\"vfb-item vfb-item-currency vfb-right-third\" id=\"item-vfb-121\"><label for=\"vfb-121\" class=\"vfb-desc\">Annual Gross Revenue <\/label><input type=\"text\" name=\"vfb-121\" id=\"vfb-121\" value=\"\" class=\"vfb-text vfb-medium number \" \/><\/li><\/ul> <\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-5 business-banking-information \" id=\"item-vfb-115\"><div class=\"vfb-legend\"><h3>Business Banking Information<\/h3><\/div><ul class=\"vfb-section vfb-section-5\"><li class=\"vfb-item vfb-item-text \" id=\"item-vfb-123\"><label for=\"vfb-123\" class=\"vfb-desc\">Business Banking Institution Name <\/label><input type=\"text\" name=\"vfb-123\" id=\"vfb-123\" value=\"\" class=\"vfb-text vfb-medium \" \/><\/li><li class=\"vfb-item vfb-item-phone \" id=\"item-vfb-125\"><label for=\"vfb-125\" class=\"vfb-desc\">Business Bank Phone <\/label><input type=\"tel\" name=\"vfb-125\" id=\"vfb-125\" value=\"\" class=\"vfb-text vfb-medium phone \" \/><\/li><li class=\"vfb-item vfb-item-address \" id=\"item-vfb-124\"><label class=\"vfb-desc\">Business Bank Address <\/label><div><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-124[address]\" id=\"vfb-124-address\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-124-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-124[address-2]\" id=\"vfb-124-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-124-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-124[city]\" id=\"vfb-124-city\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-124-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-124[state]\" id=\"vfb-124-state\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-124-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-124[zip]\" id=\"vfb-124-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium \" \/><label for=\"vfb-124-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-124[country]\" class=\"vfb-select \" id=\"vfb-124-country\"><option value=\"\" selected='selected'><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palestinian Territory\">Palestinian Territory<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\">United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Western Samoa\">Western Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><label for=\"vfb-124-country\">Country<\/label><\/span><\/div><\/li><li class=\"vfb-item vfb-item-radio vfb-left-half\" id=\"item-vfb-126\"><label class=\"vfb-desc\">Type of Account(s) <\/label><div><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-126\" id=\"vfb-126-1\" value=\"Checking\" class=\"vfb-radio \" \/><label for=\"vfb-126-1\" class=\"vfb-choice\">Checking<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-126\" id=\"vfb-126-2\" value=\"Savings\" class=\"vfb-radio \" \/><label for=\"vfb-126-2\" class=\"vfb-choice\">Savings<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-126\" id=\"vfb-126-3\" value=\"Money Market\" class=\"vfb-radio \" \/><label for=\"vfb-126-3\" class=\"vfb-choice\">Money Market<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-126\" id=\"vfb-126-4\" value=\"Other\" class=\"vfb-radio \" \/><label for=\"vfb-126-4\" class=\"vfb-choice\">Other<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-number vfb-right-half\" id=\"item-vfb-122\"><label for=\"vfb-122\" class=\"vfb-desc\">Account Number <\/label><input type=\"text\" name=\"vfb-122\" id=\"vfb-122\" value=\"\" class=\"vfb-text vfb-medium digits \" \/><\/li><li class=\"vfb-item vfb-item-instructions \" id=\"item-vfb-129\"><label class=\"vfb-desc\">Upload Supporting Documentation <\/label>(If our loan consultant asked you for specific documents, please upload them below)<\/li><li class=\"vfb-item vfb-item-file-upload vfb-left-half\" id=\"item-vfb-127\"><label for=\"vfb-127\" class=\"vfb-desc\">Upload Driver's License or Government Issued ID <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"file\" name=\"vfb-127\" id=\"vfb-127\" value=\"\" class=\"vfb-text vfb-medium required {accept:'pdf|jpeg|png|jp?g|tiff'}\" \/><\/li><li class=\"vfb-item vfb-item-file-upload vfb-right-half\" id=\"item-vfb-131\"><label for=\"vfb-131\" class=\"vfb-desc\">Upload Check Stubs or W-2's <\/label><span class=\"vfb-span\"><input type=\"file\" name=\"vfb-131\" id=\"vfb-131\" value=\"\" class=\"vfb-text vfb-medium {accept:'pdf|jpeg|png|jp?g|tiff'}\" \/><label>(if applicable)<\/label><\/span><\/li><li class=\"vfb-item vfb-item-file-upload vfb-left-half\" id=\"item-vfb-128\"><label for=\"vfb-128\" class=\"vfb-desc\">Upload Necessary Tax Returns <\/label><span class=\"vfb-span\"><input type=\"file\" name=\"vfb-128\" id=\"vfb-128\" value=\"\" class=\"vfb-text vfb-medium {accept:'pdf|jpeg|png|jp?g|tiff'}\" \/><label>(if applicable)<\/label><\/span><\/li><li class=\"vfb-item vfb-item-file-upload vfb-right-half\" id=\"item-vfb-130\"><label for=\"vfb-130\" class=\"vfb-desc\">Upload Bank Statements <\/label><span class=\"vfb-span\"><input type=\"file\" name=\"vfb-130\" id=\"vfb-130\" value=\"\" class=\"vfb-text vfb-medium {accept:'pdf|jpeg|png|jp?g|tiff'}\" \/><label>(if applicable)<\/label><\/span><\/li><li class=\"vfb-item vfb-item-instructions \" id=\"item-vfb-135\"><label class=\"vfb-desc\">Applicant Signature <\/label>By submitting this application, I ask that BARTHELEMY COMMERCIAL CAPITAL, LLC (\"you\") find a loan for me. I certify that I Consent to Electronic Communications with BARTHELEMY COMMERCIAL CAPITAL, LLC. I am providing this information to BARTHELEMY COMMERCIAL CAPITAL, LLC and it's third party providers. I consent to BARTHELEMY COMMERCIAL CAPITAL, LLC and any other owner or servicer of my account contacting me about my account, including using any contact information or cell phone numbers I provide, and I consent to the use of any automatic telephone dialing system and\/or an artificial or prerecorded voice when contacting me, even if I am charged for the call under my phone plan. I also authorize and direct you to furnish information about me (including whether this application is approved or declined) and, if it is approved, information about my Account, to BARTHELEMY COMMERCIAL CAPITAL, LLC and it's third party providers (and its affiliates and licensees) for use in connection with the BARTHELEMY COMMERCIAL CAPITAL, LLC and it's third party providers lending\/funding\/credit program, including to create and update their customer records for me, to assist them in better serving me, and to provide me with notices of special promotions, catalogs and tailored offerings. You may obtain information from others about me (including requesting reports from consumer reporting agencies and other sources) to evaluate my application, and to review, maintain, or collect my account. I understand that if my application is approved, the BARTHELEMY COMMERCIAL CAPITAL, LLC and it's third party providers Loan and or Credit Card or Credit Line\/Advance agreement (\"Agreement\") will be sent to me and will govern my account. Among other things, the Agreement: (1) includes a resolving a dispute with arbitration provision that limits my rights unless I reject the provision by following the provision's instructions; and (2) makes each applicant responsible for paying the entire amount of the credit extended.\r\nFederal law requires us to obtain, verify, and record information that identifies you when you open an account. We will use your name, address, date of birth, and other information for this purpose.\r\n\r\n I agree that I have read and agree to the above provisions and the Privacy Policy and the Consent to Electronic Communications (confirming my acceptance to receive communications electronically) set forth above. Clicking submit constitutes my electronic signature.<\/li><li class=\"vfb-item vfb-item-checkbox vfb-left-half\" id=\"item-vfb-136\"><label class=\"vfb-desc\">Check here if you agree to the above statement. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-136[]\" id=\"vfb-136-0\" value=\"Yes, I agree to the above statement.\" class=\"vfb-checkbox required \" \/><label for=\"vfb-136-0\" class=\"vfb-choice\">Yes, I agree to the above statement.<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-text vfb-right-half\" id=\"item-vfb-137\"><label for=\"vfb-137\" class=\"vfb-desc\">Please type your Initials <span class=\"vfb-required-asterisk\">*<\/span><\/label><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-137\" id=\"vfb-137\" value=\"\" class=\"vfb-text vfb-medium required \" \/><label>By Initialing and submitting this application, this serves as your signature.<\/label><\/span><\/li><li class=\"vfb-item vfb-item-instructions \" id=\"item-vfb-415\"><label class=\"vfb-desc\">Privacy Policy <\/label>Financial companies choose how they share your personal information. Federal law gives\r\nconsumers the right to limit some but not all sharing. The type of service we require has to be shared for the normal course of business. You can opt out of this sharing by not submitting your information. Federal law also requires us to tell you\r\nhow we collect, share, and protect your personal information. Please read this notice carefully\r\nto understand what we do.\r\nWhat? The types of personal information we collect and share depend on the product or service you have\r\nwith us. This information can include:\r\n\u2022 Social Security number and income\r\n\u2022 Account balances and account transactions\r\n\u2022 Credit scores and payment history\r\nHow? All financial companies need to share customers\u2019 personal information to run their everyday\r\nbusiness. How does BCCC collect my\r\npersonal information?\r\nWe collect your personal information when you fill out an application from our company on or offline.To protect your personal information from unauthorized access and use, we use\r\nsecurity measures that comply with federal law. These measures include computer\r\nsafeguards and secured files and buildings.\r\nAdditionally, BCC requires and trains its employees to comply with its privacy standards\r\nand policies, which are designed to protect customer information.<\/li><\/ul> <\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-6 verification \" id=\"item-vfb-75\" style=\"display:block\"><div class=\"vfb-legend\"><h3>Verification<\/h3><\/div><ul class=\"vfb-section vfb-section-6\"><li class=\"vfb-item vfb-item-secret\" style=\"display:block\"><label for=\"vfb-76\" class=\"vfb-desc\">Please enter any two digits <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-76\" \/><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-76\" id=\"vfb-76\" value=\"\" class=\"vfb-text vfb-medium required {digits:true,maxlength:2,minlength:2} \" style=\"display:block\" \/><label>Example: 12<\/label><\/span><li style=\"display:none;\"><label>This box is for spam protection - <strong>please leave it blank<\/strong>:<\/label><div><input name=\"vfb-spam\" \/><\/div><\/li>\n\t\t\t<li class=\"vfb-item vfb-item-submit\" id=\"item-vfb-77\">\n\t\t\t\t<input type=\"submit\" name=\"vfb-submit\" id=\"vfb-77\" value=\"Submit\" class=\"vfb-submit \" \/>\n\t\t\t\t<\/li><\/ul>\n\t\t\t<\/fieldset><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F4421\" \/><\/form><\/div> <!-- .visual-form-builder-container -->\n<div id=\"themify_builder_content-4421\" data-postid=\"4421\" class=\"themify_builder_content themify_builder_content-4421 themify_builder\">\n <\/div>\n<!-- \/themify_builder_content -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false},"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P28eiv-19j","builder_content":"","_links":{"self":[{"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/pages\/4421"}],"collection":[{"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/barthelemycc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4421"}],"version-history":[{"count":3,"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/pages\/4421\/revisions"}],"predecessor-version":[{"id":4424,"href":"https:\/\/barthelemycc.com\/index.php?rest_route=\/wp\/v2\/pages\/4421\/revisions\/4424"}],"wp:attachment":[{"href":"https:\/\/barthelemycc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4421"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}