PYWS-Intake-Form

Lender Questionnaire

Solidus [Qualified Funds]
Name*

Lender First NameLender Last Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Spouse's Full Name
(Optional)
Amount to loan?*
In USD
Source of Funds*
Who is your checkbook IRA custodian?*
YesNo
Lender Business Name
(Only complete this field if you have an LLC with a Checkbook IRA)
Jorge Diaz (jdiaz@advantaira.com)Larissa Greene (lgreene@advantaira.com)Hannah Harrison (hharrison@advantaira.com)Other Agent
Advanta Account #*
If you have checkbook control with a custodian OTHER than Advanta IRA, enter N/A here
Duration of Note*
Please select the option you prefer
Advanta Rep Email*
example@example.com
Vesting/Titling
Please verify with your custodian how the loan should be titled
Vesting/Titling
Please verify with your custodian how the loan should be titled
By checking this box, I consent to allow Position Yourself Wealth Strategies and Solidus to communicate with me regarding the information provided. I acknowledge that the information shared does not include sensitive financial data. Furthermore, I confirm that I have read, understood, and agree to the Terms of Service, Privacy Policy, and Disclaimer of both Position Yourself Wealth Strategies and Solidus websites.*

I Consent
I Certify and Agree
Special Notes
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Lender Questionnaire

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