Credit Application for Alternative Risk Transfer Loan

Einstein Capital, LLC 
8306 Wilshire Blvd, Suite 313
Beverly Hills, California  90211

Part I. Application Information

Company Name:     Federal Employer Identification Number (EIN):  

Authorized Individual Name:    Title:  

Company Type:    Date Business Commenced: :  

Industry:    Website: 

Office Phone:    Email:    Cell Phone:   

Mailing Address:   City:   State:    Zip: 

Who Referred You:  

Part II. Loan Requested

Please specify the amount of loan principal requested. 

Amount Requested:


Part III. Financial Information

A. Financial Position. Please provide the following company financial information. For Balance Sheet items, please  use 12/31 figures. If 3 quarters of financial information is available for the current year, you may use those figures along  with last year's data: 

Last Year                         Prior Year

Total Revenues:          
Total Expenses:          
Net Income:                
Total Assets:               
Net Assets:                 
Cash Accounts:          
Total Liabilities:           
Current Liabilities:       
Owners Equity:           


B. Financial Statements. Please attach copies of the Applicant’s tax returns for the past 2 years (pages 1 and 2 of Form 1040 or 1120, or equivalent )or financial statements for organizations for the past 2 years: 


Part IV. Outstanding Debt

Please provide any currently outstanding debt information in the spaces provided below:

A. Creditor:   Principal:   Due Date: 

Length of Term:    Payment Amount: 


B. Creditor:   Principal:   Due Date: 

Length of Term:    Payment Amount: 


C. Creditor:   Principal:   Due Date: 

Length of Term:    Payment Amount: 

Part V. Important Information

The information contained in this application and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant. Applicant understands it is applying for Alternative Risk Premium Funding through Einstein Capital and/or affiliates. All loans subject to approval. 

Applicant warrants that the above information represented in this application, and financial statements, profit and loss statements, statements as to ownership, and other statements given to Einstein Capital and/or affiliates are true and correct. In making this application, Applicant understands and acknowledges Einstein Capital will be relying on the information provided in determining creditworthiness and to grant such credit.

Applicant represents by this application that the Company is a going concern, that the business will be continued, and that Company understands that the proceeds of the loan will be used in connection with Alternative Risk Transfer Funding payable directly to the insurer. 

This Application is part of the Loan Documents. Loan is subject to terms and conditions contained within the Loan Documents. Loan approval and terms subject to final determination by Einstein Capital Underwriters. Loans may not be approved for use in all jurisdictions.

It is recommended that you consult legal advice regarding Alternative Risk Transfer Funding. Nothing in this Application is intended to induce reliance by the Applicant nor should Applicant rely on loan amount disbursement until a final determination letter is issued.
This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant on the date given below. Einstein Capital and/or affiliates are authorized to make all inquiries it deems necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the Applicant. Applicant will promptly notify Einstein Capital of any subsequent changes which would affect the accuracy of this Statement. Applicant is aware that any knowing or willful false statements regarding the value of the above property for purposes of influencing the actions of a creditor can be a violation of U.S. Federal law,18 U.S.C. Sec. 1014, and may result in a fine  or imprisonment or both.

I have the authority to, and wish to obtain a financial loan through Einstein Capital; the information in this application is true and correct to the best of my knowledge; no false representations, warranties, nor was false information was provided; I agree to the terms and conditions outlined herein; and I agree to the understandings, representations and warranties above:


By signing below, the undersigned agrees to all the terms and conditions contained in this Application. 

Company Name:  Authorized Individual Name: 

You acknowledge, by submitting this application you agree to the terms and conditions herein, if you do not agree please do not
submit this application. Thank you.