SSG EEO Services
Business Funding - Intake Form
Business Financing Request
SSG EEO Services
Financing Type
Term Loan
Line of Credit
SBA Loan
Merchant Cash Advance
Equipment Financing
Franchise Financing
Other
If other, please explain
Requested Loan Amount
Borrower Name
First Name
Last Name
Borrower Date of Birth
-
Month
-
Day
Year
Date
Best Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best Email Address
example@example.com
Co-Borrower Name
First Name
Last Name
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Monthly Revenue Last 3 Months:
Month 1 - Revenue
Month 2 - Revenue
Month 3 - Revenue
Equipment Value
Franchise Name
How will financing be held?
As Individual
As Entity
If entity: What is entity name?
Credit Score
Please provide the reason for the loan. (Example: I will use the loan for...)
Property or Asset Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Name
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Notes
Appointment
Submit
Should be Empty: