Working Capital Express Application

Please fill in the information below. Information is required unless noted as optional.

All fields marked with * are required.

Amount Requested

($5,000 minimum)

Payment Plan You're Interested In: (Number of months) *

Business Information

(Legal business name as registered with the Secretary of State; if sole prop or IC, type your name.)


Personal Information

Do you have a checking account? *

Do you have a savings account? *

Authorization and Disclosure

I hereby authorize the release of business and/or personal credit information to NCMIC Finance Corporation (NCMIC), its affiliates or assignees (1) from any source including credit bureau reporting agencies and my bank for the purpose of extending credit, and (2) to any credit reporting agency. I also hereby authorize NCMIC to order a credit report in connection with the administration, review, or collection of my account and in connection with offering additional products and services to me. Additionally if my application is not approved by NCMIC, I hereby authorize the release of my application without notice, to any other potential lending sources not related to NCMIC Finance Corporation for consideration of approval of credit. I hereby represent all information is true, correct and complete. A photo static, facsimile, or other electronic copy of this authorization shall be valid as the original. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or a part of the applicant's income derives from any public assistance programs, or because the applicant has in good faith exercised any rights under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. To help the Government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. This means that when you apply for credit or open an account with NCMIC we will ask for your name, address, date of birth, social security number, and other information that will allow NCMIC to identify you. We may also require that you furnish NCMIC with a copy of your Driver's License or other identifying documents. Consult your attorney or financial advisor for specific legal and/or tax advice before entering into any type of financing arrangement, and for information on tax deduction eligibility and procedures. 

* I have read the Authorization and Disclosure and:

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Equipment Loan     Working Capital Loan