Funding Pre-Qualification Questionnaire
Name
*
First Name
Last Name
Referred by
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Birthdate
*
-
Month
-
Day
Year
Date
Amount of Funding Needed ($10,000-$400,000)
*
Funding Purpose
*
1. Are you a U.S Citizen?
*
Yes
No
2. Do you reside in Iowa or California?
*
Yes
No
3. Do you have a Credit Score of 660 or higher on all 3 credit bureaus?
*
Yes
No
4. Do you have at least 3 open tradelines reporting on your credit report?
*
Yes
No
5. Is Your Income $27,000 or more Annually?
*
Yes
No
6. Do you have less than 6 inquiries in the last 6 months?
*
Yes
No
7. Do you have new credit lines open in the last 6 months (credit cards, credit card limit increases, car loan, mortgage, personal loan etc?)
*
Yes
No
8. Have you ever flied for bankruptcy?
*
Yes
No
9. If you have filed bankruptcy, is it at least 2 yrs. discharged?
*
Yes
No
N/A
10. Are you employed or self-employed?
*
Employed
Self-Employed
Both
11.If employed, have you been employed in your current position a minimum of 6 months, with at least 1 yr of continuous employment?
*
Yes
No
N/A
12.If self-employed, have you been in business and filed taxes for the last 2 years?
*
Yes
No
N/A
13.If self-employed, do you have a gross business income of at least $50,000 and a minimum net business income of $27,000 on your most recent 2 years of tax filings?
*
Yes
No
N/A
14.If self-employed, do you pay yourself a salary?
*
Yes
No
N/A
15.If self-employed, what is your business structure?
*
LLC
C-Corp
S-Corp
1099 (Independent Contractor)
16. Do you have any late payments, collections, judgements or anything that is derogatory reporting that is reporting in the last 2 years?
*
Yes
No
17. Do you have any medical bills reporting?
*
Yes
No
18. Do you have at least 50% left on your current credit card balances?
*
Yes
No
By submitting this form, you agree that the information provided is correct to your knowledge. The information provided in this form will not be shared and is kept confidential.
Submit
Should be Empty: