Business Funding Quote

Pre-Qual Form

Owner Name & % of Ownership

Co-Owner & % of Ownership

Business Address

City, State, Zip Code

Business Phone:

Business Email:

Business Legal Name:

Business Start Date:

Avg monthly revenue for last 6 months

Do you accept credit cards ?

Is this a home-based business ?

Desired Funds Needed:

Purpose of Funds Needed:

When do you need the funding ?

What Industry are you in ?

Any bankruptcies ? When ?

If yes, month & year it was discharged

Any Liens or judgements ?

If yes, what month and year ?

Have you gone through credit repair ?

Does business have assets/equipment ?

Looking to finance any equipment ?

Do you have a website ? If so, what is it ?

Any existing Cash Advances or Loans ?

1st Loan Payment

1st Schedule & Method

1st Maturity Date

2nd Loan Payment

2nd Schedule & Method

2nd Maturity Date

3rd Loan Payment

3rd Schedule & Method

3rd Maturity Date

Additional Comments:

I confirm the info I have provided is accurate to the best of my knowledge. I understand this info will be used solely to provide a "soft-quote" for business funding and that receiving such does not constitute an official pre-approval.

Business Funding Quote

Pre-Qual Form

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