Personal Loan Application

Please Note: 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.
Loan Amount

Personal Information

First Name *
Middle Name or Initial
Last Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email Address *
Contact Phone *
Work Phone *
Date of Birth *
Social Security Number *Please enter your valid social security number.
Source of Income *
Self EmployedEmployedOther
If Other, Please list source of income
Annual Gross Income *
How Often Paid? *
Name of Employer
Employer or Business Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Employer Phone
Date You Started Working with this Employer *
May we contact your Employer to verify?
YesNo
Do You Rent Or Own Your Home? *
RentOwnOther
How Much Is Your Rent or Mortgage per Month?

Personal Banking Information

Name of Banking Institution
Bank Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Bank Phone
Type of Account (s)
CheckingSavingsOther
Account Number
Please list any other assets here.

Business Information

Name of Business
Business Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Business Phone
Business Email
Business Website
Type of Business
Date Business Started
Business Structure
Name of Principal or Authorized Officer of Business
Number of Employees
Do you rent or own your business location?
RentOwnHomebasedMobile
Federal Tax ID# (EIN)
Dun and Bradstreet Number
Annual Gross Revenue

Business Banking Information

Business Banking Institution Name
Business Bank Phone
Business Bank Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Type of Account(s)
CheckingSavingsMoney MarketOther
Account Number
Upload Supporting Documentation (If our loan consultant asked you for specific documents, please upload them below)
Upload Driver's License or Government Issued ID *
Upload Check Stubs or W-2's (if applicable)
Upload Necessary Tax Returns (if applicable)
Upload Bank Statements (if applicable)
Applicant Signature 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. Federal 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. 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.
Check here if you agree to the above statement. *
Yes, I agree to the above statement.
Please type your Initials *By Initialing and submitting this application, this serves as your signature.
Privacy Policy Financial companies choose how they share your personal information. Federal law gives consumers 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 how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. What? The types of personal information we collect and share depend on the product or service you have with us. This information can include: • Social Security number and income • Account balances and account transactions • Credit scores and payment history How? All financial companies need to share customers’ personal information to run their everyday business. How does BCCC collect my personal information? We 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 security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. Additionally, BCC requires and trains its employees to comply with its privacy standards and policies, which are designed to protect customer information.

Verification

Please enter any two digits *Example: 12
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