Business Assessment Form

Business Assessment Form

(Pre-qualification for potential credit or financing)
Name*

First NameLast Name
Business Name*
Email*
example@example.com
Business or Mobile Number (For Calls and Text Messaging)*
Format: (000) 000-0000.
In a few words, describe the type of business you have*
List the State your Business is located in*
Is your business name registered with your Secretary of State?*
Single Member LLCS-CorpCorporationSole ProprietorPartnershipDBAOther
What year did you register your business?*
Do you have an EIN (Employer Identification Number)?*
Brick & MortarVirtual AddressP.O. Box or UPS BoxHome AddressOther
Home/Personal Cell PhoneBusiness Cell PhoneBusiness LandlineVOIP 1-800 or Local NumberGoogle Business VOIPOther
Is your business name and phone number listed in the 411 directory database?*
Do you have a Dun & Bradstreet (D-U-N-S) number?*
Does your business have a website?*
Does your business have a professional email address (not @gmail, @hotmail, @yahoo, etc...?*
Do you have a business checking account separate from your personal checking account?*
The following questions are used to determine if you are able to IMMEDIATELY qualify for any type of financing for your business.
Is your business name, business address, and business phone number consistent on all of your business documents - including your bank account?*
What is your Cash Monthly Gross Revenue?*
What is your Personal Credit Score?*
Do you have any of the following Collateral?*
Should be Empty: