Business Funding Form

1

How long have you been in business?* This field is required.

0 - 6 months

6 -12 months

1-2 years

2 years or longer

2

What is your Gross Monthly Revenue?* This field is required.

Less than $15,000

$15,000-$25,000

$25,000-$50,000

$50,000-$100,000

$100,000 or more

3

What is the range of your current personal credit score* This field is required.

Less than 600

600-650

650-700

700 or more

4

Do you have established business credit?* This field is required.

Yes

No

5

Do you have any outstanding loans?* This field is required.

Yes

No

6

What is the loan needed for?* This field is required.

Payroll and/or Maintenance

New Business Location

Marketing & Advertising

New Equipment

Renovations

Other

7

How much funding does your business need?* This field is required.

$10,000-$25,000

$25,000-$50,000

$50,000-$100,000

$100,000 or more

8

Name* This field is required.

First Name

Last Name

9

Name of Business* This field is required.

10

Email* This field is required.

example@example.com

11

Phone Number* This field is required.

Please enter a valid phone number.