"FUNDING MY FUTURE" business credit pilot program intake form

"FUNDING MY FUTURE" business credit pilot program intake form
Contact Info
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a spouse or business partner you'd be funding along with?*

YesNo
Please have your spouse/partner fill out this form as well. State their name below
Credit Info
What is your personal credit score?*

800 -850740 - 799680 - 739580 - 680Below 580Not Sure
How many personal credit cards do you have?*

Less than 22 to 55 to 10Over 10None
What are the average limits of your personal credit cards?*

$10k or higher$5k to $10k$2,500 to $5kLess than $2,500
What's the average age of your personal credit cards?*

2 years or older1-2 years6 months to one yearLess than 6 monthsNot sure
Any loans in past or present? (Check all that apply)*

Home/mortgageAutoStudent LoansPersonal LoansOther
What is your current overall credit utilization?*

Less than 10%10% - 30%30% - 60%Higher than 60%Not sure
How many inquiries show up on your credit report in the last 12 months, across all bureaus*

Less than 33 to 66 to 9More than 9Not sure
Do you have a W-2?*

YesNo
What is your W-2 income? (gross)*

Below $40k$40 - $80k$80-$150kMore than $150k
What is your income? (gross)*

Below $40k$40 - $80k$80-$150kMore than $150k
Business Information
Do you have a business entity? (LLC, Corporation etc)*

YesNo
What is the age of your entity?*

More than 2 years1-2 yearsLess than 1 yearBrand newNot sure
In what state is your business registered? *
Is your entity multi-member or sole proprietor?*

Sole ProprietorMulti-Member LLCSingle Member LLCCorporation/other
What is your annual business revenue (gross)*

None/pre-sales0 to $20k$20k - $100k$100k - $250kAbove $250k
Do you have... (Check all that apply)*

A Business EINBusiness Address (not a PO Box)Dedicated Business Phone NumberDUNS NumberBusiness websiteBusiness email with custom domain (not gmail/yahoo etc)A listing on 411A Business Fax NumberA Nav Account
Do you know your business credit scores?*

YesNo idea
Do you have... (Check all that apply)*

Business Checking AccountBusiness Savings AccountBusiness Trade linesBusiness Credit CardsBusiness Lines of CreditBusiness Loans
What is your business entity name? *
What industry is your business in? *
How many business entities do you have in all? (all states) *
Lifestyle Info
In general, do you have more money or more time?*

I have both money and time in good supplyI have more money than I do timeI have more time than I do moneyNone of either!
Have you Identified your financial freedom numbers?*

YesNoPartially
If so, list them here*
In general, how do you prefer to approach new things?*

I like to learn and do the work myself and make the mistakes but retain control, even if it takes longerI prefer to have a professional guide and do the things for me where possible, and shorten the time to the goal
Have you identified your ideal dream lifestyle?*

YesNot Yet
Do you have a clear idea of what you’d do with funding to generate income or time if you had it now?*

YesNot Quite
Describe some things you would do in business/investment if funding were not an issue?*
Should be Empty:

"FUNDING MY FUTURE" business credit pilot program intake form

Contact Info

Credit Info

Business Information

Lifestyle Info