Form cover
Page 1 of 1

Small Business Financing Application

Emerald Crest Capital follows a progressive lending structure designed to protect both borrowers and the lending facility.

Clients begin with smaller facilities and may qualify for larger financing after successful repayment.

Section 1- Applicant Information

Person Information

Full Name

Phone Number

Email Address

National I.D Number

Business Information

Business Name

Business Location

Years In Operation

Years In Operation
A
B
C
D

Business Type

Business Type
A
B
C
D
E

If other, please specify

Section 2- Financing Request

Amount Requested

Amount Requested
A
B
C
D
E
F
G
H

Purpose of Financing

Estimated Monthly Revenue

Estimated Monthly Revenue
A
B
C
D
E

Repayment Period Preferred

Repayment Period Preferred
A
B
C

Section 3- Business Verification

Do you have business records or sales tracking?

Do you have business records or sales tracking?
A
B

Do you operate from a physical location?

Do you operate from a physical location?
A
B

Business Social Media (optional)

Section 4: Documentation and Referrals

Attach Documents

Personal ID

Business Mpesa statement or Bank statement for latest 3 months

Guarantor Details

Full Name

Mobile Number

Email Address (optional)

* Please note that we reserve the right to contact said guarantor for verification and awareness.

Section 5- Declaration

I confirm that the information provided is accurate and understand that all applications are subject to internal review

I confirm that the information provided is accurate and understand that all applications are subject to internal review