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Your name
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Your email address
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Your phone number
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Would you prefer we follow up with you via
Text
Phone call
Email
WhatsApp
What is your overall goal for financing?
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What amount were you looking for?
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Are you hoping to use your financing for any of these things?
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Real Estate Purchase / Refinance
Equipment Purchase / Refinance
Inventory Purchase
Raw Materials Purchase
Refinancing of Debt (short or long term)
Working Capital
Hiring of New Staff
Operating Expenses (advertising, marketing)
Start-Up Expenses
Other
If other, list here:
What would you use the money for? (If for several uses, please break that out. Example: total amount needed: $X. Of which equipment: $X, inventory: $X, marketing: $X)
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Business Name
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Business Address
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Business website URL
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Where can we find your business on social media?
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(e.g. LinkedIn, Instagram, Facebook)
Date of Founding?
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Type of business structure? (ex: LLC, Corp)
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Revenue for 2021 (as on your tax return)?
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Net income for 2021 (as on your tax return)?
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EBITDA for 2021?
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Revenue for 2020 (as on your tax return)?
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Net income for 2020 (as on your tax return)?
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EBITDA for 2020?
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Revenue so far for 2022? And what do you expect for full year 2022?
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Net Income so far for 2022? And what do you expect for full year 2022?
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What revenue and net income do you expect for 2023?
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Cash on hand?
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Total accounts receivable?
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Total value of finished goods inventory?
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Total value of other assets and please list them.
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Total accounts payable?
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Do you currently have any credit card debt in your business? If so, how much?
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Do you have any business loans? If so, please list each one, current balance, and monthly payment.
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Any other debt, such as credit cards? If so, please list each one, current balance, and monthly payment.
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Your personal income in 2021?
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Your personal income in 2020?
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If you file taxes jointly, total household income in 2021?
If you file taxes jointly, total household income in 2020?
Personal cash on hand? (checking & savings accounts)
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Do you own or rent?
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Own
Rent
Monthly payment for your living situation
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Monthly car payments?
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Average monthly credit card payments?
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Other monthly expenses (i.e. household expenses)? Please list types and amounts.
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Your personal credit score?
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Your spouses' credit score? (if you file jointly)
If you have any other owners in the company that own more than 20% of the company, what is their personal credit score?
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If you have any other owners in the company that own more than 20% of the company, what is their personal income in 2020?
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If you have any other owners in the company that own more than 20% of the company, what is their personal income in 2019?
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Do you have a 20% or more stake in any other businesses?
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Yes
No
If so, please provide 2021 revenue and net income for each.
If so, please provide 2020 revenue and net income for each..
Any other information you'd like to provide for consideration?
Thank you for completing this form. The time you took is very valuable and will help me to determine exactly what you will qualify for.
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