Funding Application

If you have not completed an application, please fill out the information below.
If you have already completed and signed application and would like to submit it along with your support documents, please use our Document Submission Form.
If you have any questions please call us at 713-352-7088
CLICK HERE TO
SUBMIT DOCUMENTS
Print, Sign, Scan & Submit
through our online
Document Submission Form
Business Name*
(requesting financing)
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax*
Federal ID#*
Federal taxes past due?*
- Yes
- No
Federal Amount Due*
State taxes past due?*
- Yes
- No
State Amount Due*
Have you ever filed bankruptcy?*
- Yes
- No
Where?*
Date of Bankruptcy*
MM slash DD slash YYYY
Other business names used within the past five (5) years (one per line)
Is Company incorporated?*
- Yes
- No
What State?
Number of employees
Number of owners to represent > 62% ownership.*
1st Owners Name*
Full Name
Title*
(Position)
Home Address*
Street Address City State ZIP Code
Phone*
Social Security #*
Driver's License # / State*
Percent of Company owned*
Email*
2nd Owners Name*
Full Name
Title*
(Position)
Home Address*
Street Address City State ZIP Code
Phone*
Social Security #*
Driver's License # / State*
Percent of Company owned*
Email*
3rd Owners Name*
Full Name
Title*
(Position)
Home Address*
Street Address City State ZIP Code
Phone*
Social Security #*
Driver's License # / State*
Percent of Company owned*
Email*
Average Monthly Sales*
Outstanding Receivables*
Approximate # of customers*
Terms of Sale*
Name of Bank
i.e. Wells Fargo NA
Phone
Bank Address
Street Address City State ZIP Code
Account Officer
Full Name
Account #
Are there any liens against any receivables?*
- Yes
- No
To Whom*
Are any other assets assigned, pledged or liened?*
- Yes
- No
To Whom*
Who referred you to us?
ALL OF THE ABOVE STATEMENTS ARE TRUE AND ACCURATE TO THE BEST OF MY INFORMATION AND BELIEF. SIGNATURE ON THIS FORM
CONSTITUTES PERMISSION TO RELEASE ANY AND ALL FINANCIAL INFORMATION REQUESTED TO AMERICAN PRUDENTIAL CAPITAL, INC.
Funding Your B2B Future Today
Funding Your B2B Future Today
Funding Your B2B Future Today
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Funding Your B2B Future Today

Worldwide Headquarters:
10216 Fairbanks N. Houston Rd. Houston, Texas 77064
713-352-7088
713-690-8855
info@americanprudentialcapital.com

About Our Company

American Prudential Capital, Inc. exists to serve by enhancing value. We believe that the industry of small businesses is what has made the United States great and will continue to be the backbone of this country. We want to help small businesses finance growth and expansion while facilitating the company’s own business processes of complete, accurate invoicing.

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Funding Your B2B Future Today

Funding Your B2B Future Today

Funding Your B2B Future Today

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Funding Your B2B Future Today

About Our Company

Connect With Us