Specialty Funding / Pre-Approval Questionnaire

Pre-Approval Questionnaire

Specialty Business Funding Program: $25k to $200k In 5-7 Business Days
Owner's Name: *

First Name Last Name
Legal Business Name: *
Ex: J.L. Smith Enterprises, LLC.
DBA: *
Ex: Joe's Pizzeria
Business Address: *

*(P.O. Box's, Mailbox Addresses, UPS (Type) Stores, Shared or Virtual Offices etc. Will Not Qualify)

Suite/Unit #

City State

Zip Code
Business Phone Number: *

Area Code Phone # *Google Voice #'s or Alternate (Type) of #'s Will Not Qualify.
Cell Phone Number: *

Area Code Phone # *Google Voice #'s or Alternate (Type) of #'s Will Not Qualify.
Email Address: *
example@example.com
1) This program is for U.S. based businesses only. Are you a U.S. based business? *

Yes No
2) How long has your business been open? *
Type time in business Ex: 7.5 years
3) Do you have a personal credit score 680+ or higher? *

Yes No I don't know
4) Does your business have a Paydex Score of 70+ or higher? *

Yes No I don't know
5) Does your business have any open judgements against it? *

Yes No
6) What is your average gross monthly revenue? *
Ex: $40,000.
7) Is your business currently in or have ever been in bankruptcy? *

Yes No
8) Which best describes your physical business address? *

Brick & Mortar Home-Based Online (Internet Based) UPS Store, Mail Store or P.O. Box
9) Within the last 7 years does your business have any of the following successful transactions: (click all that apply) *

A true bank loan A true bank line of credit An equipment lease or finance All of the above None of the above
10) Are you open to a creative financing vehicle that will not interfere with your ability to qualify for additional funding? *

Yes No
11) Does your business have 3 or more recently defaulted MCA payments (within the last 30 days)? *

Yes No
12) Has your business ever had a total MCA default? *

Yes No
13) Are you interested in 5 year funding payback with monthly payments? *

Yes No
14) Do you have a D&B Business Credit Profile? *

Yes No
15) What is your Dun & Bradstreet # ?
16) How much capital are you seeking? *
Type $ Dollar amount of loan
Purpose of Funds? *
How will you use the proceeds?
Referred By:
Who referred you?
Please verify that you are human *
Should be Empty:

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