TipTop Capital

Worksheet

Sales Rep

Business Name*

First Name*

Last Name*

Deposit Revenue (Breakdown)

Monthly Revenue

Credit Card Volume

Other

Email*

Phone*

Business Address:

OPEN POSITIONS (Current Advances!) 1

Lender

Contract Amount / Balance 1

Terms (Daily, Weekly)

Zip Code

City

State

Co-Owner First Name

Co-Owner Last Name

OPEN POSITIONS (Current Advances!) 2

Lender

Contract Amount / Balance 1

Terms (Daily, Weekly)

Date Business Started: *

Use of Funds

Industry Type:

Funding Requested

OPEN POSITIONS (Current Advances!) 3

Lender

Contract Amount / Balance 1

Terms (Daily, Weekly)

Bankruptcy/ Tax Liens:

AGENT NOTES

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