Pre-qualification Form

Name*

First NameMiddle NameLast Name

Personal Email (cannot be a business email)*

example@example.com

What state is your residence?*

Phone Number *

Please enter a valid phone number.

How much do you want to borrow?*

What is the purpose of the loan?*

When do you need funding?*

Less than 2 weeks2 weeks to 1 monthGreater than 1 month (I want to see if I qualify first)Other

Are you shopping around?

YESNO

Are you a US citizen or a permanent resident with a green card and a social security number?*

YES, I am a US CitizenYES, I am a permanent resident with a green card and a social securityNO, I am not a US citizen & I do not live in the US

What is your credit score?*

What is your annual income?*

What is your source of income?*

W-2 employmentSelf-employedDisabilityRetired

Do you have less than 6 inquiries in the last 6 months?*

YESNO

Do you have new credit lines opened in the last 6 months? (new credit cards, credit card limit increases, car loan, mortgage, personal loans, refinance, etc)*

YESNO

Have you ever filed Bankruptcy? (If yes, discharge date must be at least 2 years old)*

YES (it is greater than 2 years old)YES (it is less than 2 years old)NO

Do you have any judgments or lawsuits?*

YESNO

Do you have any late payments, recent collections, or anything that is derogatory reporting in the last 2 years?*

YES (it is greater than 2 years old)YES (it is less than 2 years old)NO

Do you have at least 60% left on your current credit card balances?*

YESNO

Do you need credit repair services?

YESNOUNSURE

Pre-Qualification Form