"FUNDING MY FUTURE" business credit pilot program intake form
Contact Info
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a spouse or business partner you'd be funding along with?
*
Yes
No
Please have your spouse/partner fill out this form as well. State their name below
Credit Info
What is your personal credit score?
*
800 -850
740 - 799
680 - 739
580 - 680
Below 580
Not Sure
How many personal credit cards do you have?
*
Less than 2
2 to 5
5 to 10
Over 10
None
What are the average limits of your personal credit cards?
*
$10k or higher
$5k to $10k
$2,500 to $5k
Less than $2,500
What's the average age of your personal credit cards?
*
2 years or older
1-2 years
6 months to one year
Less than 6 months
Not sure
Any loans in past or present? (Check all that apply)
*
Home/mortgage
Auto
Student Loans
Personal Loans
Other
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 3
3 to 6
6 to 9
More than 9
Not sure
Do you have a W-2?
*
Yes
No
What is your W-2 income? (gross)
*
Below $40k
$40 - $80k
$80-$150k
More than $150k
What is your income? (gross)
*
Below $40k
$40 - $80k
$80-$150k
More than $150k
Business Information
Do you have a business entity? (LLC, Corporation etc)
*
Yes
No
What is the age of your entity?
*
More than 2 years
1-2 years
Less than 1 year
Brand new
Not sure
In what state is your business registered?
*
Is your entity multi-member or sole proprietor?
*
Sole Proprietor
Multi-Member LLC
Single Member LLC
Corporation/other
What is your annual business revenue (gross)
*
None/pre-sales
0 to $20k
$20k - $100k
$100k - $250k
Above $250k
Do you have... (Check all that apply)
*
A Business EIN
Business Address (not a PO Box)
Dedicated Business Phone Number
DUNS Number
Business website
Business email with custom domain (not gmail/yahoo etc)
A listing on 411
A Business Fax Number
A Nav Account
Do you know your business credit scores?
*
Yes
No idea
Do you have... (Check all that apply)
*
Business Checking Account
Business Savings Account
Business Trade lines
Business Credit Cards
Business Lines of Credit
Business 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 supply
I have more money than I do time
I have more time than I do money
None of either!
Have you Identified your financial freedom numbers?
*
Yes
No
Partially
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 longer
I 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?
*
Yes
Not Yet
Do you have a clear idea of what you’d do with funding to generate income or time if you had it now?
*
Yes
Not Quite
Describe some things you would do in business/investment if funding were not an issue?
*
Submit
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