Client Intake Form
Business Owner Name
*
First Name
Last Name
Name of Business
*
Website
*
if no website, please say "N/A"
Phone Number
*
E-mail
*
example@example.com
Preferred Contact Method
*
Please Select
Email
Text
Phone
Desired Loan Amount
*
Please Select
$1,000 - $10,000
$10,000 - $20,000
$20,000 - $30,000
$30,000 - $40,000
$40,000 - $50,000
Desired Loan Term
*
Our Max Loan Term is 6 months
How will funds be used?
*
Do you currently have any outstanding business loans?
*
Please Select
YES
NO
Do you have an active business entity?
*
Please Select
YES
NO
Please select your business entity.
*
Please Select
LLC - Solo-Member
LLC - Multi-Member
Corporation
Sole Proprietor (no formal entity)
In what US state is your business entity registered?
*
Have you filed for personal or business bankruptcy in the last 3 years?
*
Please Select
YES
NO
Is your entity in good standing in the state of its registration?
*
Please Select
YES
NO
Can you provide an Income Statement for the current and previous year?
*
Please Select
YES
NO
If no, would you like assistance in creating financial statements for your business?
*
Please Select
YES
NO
Are you current on your federal business tax filings?
*
Please Select
YES
NO
Do you have a personal credit score of 620 or higher?
*
Please Select
YES
NO
Are you or your business named as a defendant in any active litigation?
*
Please Select
YES
NO
Any additional information you would like to share?
*
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