MFG Business Funding Intake Form

Business Financing Intake Form
Name

First NameLast Name
PERSONAL Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Business LEGAL Name
Business Address (If home address enter here)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
BUSINESS Phone Number
Please enter a valid phone number.
BUSINESS Email
example@example.com
Industry or Type of Business
Business Phone Number
Please enter a valid phone number.
Employer ID Number (EIN)
Have you previously established Business Credit?

YesNot yet but I would like help
If yes, Name a few accounts AND Credit Line Amounts you have established for your Business
DUNS NUMBER
SAM NUMBER/UEI
Business Type

Limited Liability Company/LLCC CorpS CorpSole ProprietorshipPartnershipNON PROFIT Corportation 501 (c) 3
Have you filed your Beneficial Ownership Information Report(BOIR)

I sure have!Not yet. Have been meaning toNot yet. Need more explanation
What is your monthly Business Income BEFORE expenses?
Today, what is the balance in your main Business Bank Account?
Your Credit Personal Score?
What was your income BEFORE expenses in 2023?
What was your income YTD as of TODAY?
Please upload related documents ie., EIN Letter from IRS, Articles of Incorporation, Most Recent Business Bank Statement, 501 (C) Award Letter (if Non Profit)

Cancelof
Funding you seek

10k-25k25k-50k50k-100k100k-200k200k-500k500k-1 MillionOVER 1 MillionUNLIMITED Grant Funding
Reason for financing

Starting a new businessBuying an existing businessExpanding your current businessBuying out your partnerBringing existing business from abroadBuying real estateComercial ContructionPurchase EquipmentPurchase InventoryBridge Loan Real EstateBridge Loan Accounts ReceivableBridge Loan on Gov't ContractsOperatingOther
Please share any details about your Funding Goals here:
How soon do you need the financing approval?

Less than 15 days15 days - 1 month1 -3 months3-6 months6 months - 1 year
Information Privacy Clause: Maximus Financial Group, LLC is committed to protecting the privacy and security of the personal information provided in the Small Business Loan Application. By submitting this application, you hereby consent to the collection, use, storage, and sharing of the information provided for the purpose of assessing your eligibility for a small business loan.We will only collect information that is necessary for evaluating your loan application and will not disclose your personal information to any third parties unless required by law or with your explicit consent. Our employees who have access to your information are trained to maintain confidentiality and follow strict data security protocols.We will take reasonable steps to safeguard your personal information from unauthorized access, use, or disclosure. However, please be aware that no data transmission over the internet or method of electronic storage is completely secure, and we cannot guarantee the security of your information.By submitting this application, you acknowledge and agree to the terms outlined in this information privacy clause. If you have any concerns about the privacy of your information or wish to inquire about our data protection practices, please contact us at the following address: Maximus Financial Group, LLC 1212 E 15th Street, Wilmington, DE 19802. Your signature notates your agreement with this Privacy Statement.

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Business Financing Intake Form