New Client
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Referral
Internet
Social Media
Other (Please specify...)
Back
Next
Who's Involved?
Please List all Principal's, Board Members, and/or Members and indicate whether or not they are willing to be a personal guarantee.
*
Rows
Full Name
Address
Title
Contact Number
Email
Time in Position
Ownership Percentage
Personal Guarantee?
1
2
3
4
5
6
7
8
9
10
11
12
Back
Next
Business Info:
Business Name:
*
Business Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Email:
*
example@example.com
Website:
*
www.example.com
Back
Next
Corporate Questionnaire
Industry Space/Type:
*
Ex: Manufacturing
Project Title and Type:
*
Ex: My Company Equipment Financing
Business Model / Niche
*
Ex: Tiny Home Factory and Sales
Corporate Structure:
*
S-Corp
C-Corp
LLC
Non-Profit
Other
Special Tax Structure:
*
Please indicate if you operate as a holding company or other.
Licenses Required to Operate:
*
Ex: Business and Contractors License
List the Regions, States, and Countries that your business operates in:
*
Years in Business
*
Please Select
Less than 1 Year
Less than 3 Years
Less than 5 Years
5-10 Years
10+ Years
Are your currently Publicly Traded
*
Please Select
Yes
No
What is your Ticker Symbol:
Back
Next
Equity:
How much capital is invested?
*
Is Equity Available?
*
Back
Next
Liabilities:
Please indicate what types of debt you currently have and explain: (Check all that apply)
*
Private Debt
Institutional Debt
None
Other
Explanation:
*
Please list your total debts:
*
What is you Debt Ratio?
*
What is your CTR - Capacity to Repay?
*
Back
Next
Assets:
Please list and explain your Hard Assets:
*
Please list and explain your Soft Assets:
*
Total Assets:
*
Back
Next
Internal
Please list the systems that you have in place and the provider that you use:
CRM - Contact Relationship Manager
*
POS - Point of Sale
*
SEO - Search Engine Optimization
*
OS - Operating System
*
SOP's - Standard Operating Procedures
*
Aurtomation
*
AI - Artificial Intelligence
*
IP - Intellectual Property / Patents, and their status
*
Back
Next
Operations
Please indicate what you are looking for in the following areas of business:
Capital:
*
Please Select
Debt
Equity
Both
Other
Explanation:
*
Ex: Looking for $250K of Convertable Debt
Operational:
*
Please Select
Debt
Equity
Both
Other
Explanation:
*
Ex: Financing for Technology Upgrades
Marketing:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Internet Marketing Stategy
Legal:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Contract Review
Human Resources:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Attrition assessment and strategy
Sales:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Sales Team Strategy and Development
Fulfillment:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Fulfillment cost assessment
Supply Chain:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Supply Chain Development
Web / App Development:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: E-Commerce Store Development
Manufacturing:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Cap EX
Back
Next
Operations
Continued...
Research and Development:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Cap EX
Quality Control:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Risk Assessment
Information Technology:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Network Development
Testing:
*
Please Select
Capital
Development
Contracted
Other
Explanation:
*
Ex: Cap EX
Submit
Should be Empty: