Loan Questionnaire
Desired Loan Amount $ Min. $10k / Max$500k
Annual Income $
CREDIT SCORE- Please provide all 3 scores ( if known)
Loan will be used for
Business Launching
Real Estate
Home Improvement
Investment
Education
Other
Contact Information
Name
Title
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
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1921
1920
Year
Marital Status:
Single
Married
Other
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Citizenship
U.S. Citizen
Non-Permanent Resident Alien
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived in your given address?
0-1 Year
1-2 Years
3-4 Years
5+ Years
Have You Ever Been Late on Any payments in last 2 yrs
Yes
No
Do You Have at least 3 Trade Lines of Credit? (ex. Auto, Home, Credit Car..)
YES
NO
DO YOU HAVE ANY JUDGMENTS, LATE PAYMENTS OR COLLECTIONS ON CREDIT PROFILE?
YES
NO
ARE YOU A W-2, 1099 EMPLOYEE OR BOTH
W2
1099
BOTH
HAVE YOU EVER FILED BANKRUPTCY?
YES
NO
HAVE YOU APPLIED FOR AUTO FINANCING IN PAST 12 MOS.
YES
NO
HAVE YOU EVER UTILIZED CREDIT REPAIR/RESTORATION SERVICES
YES
NO
HAVE YOU APPLIED WITH ANY OTHER LENDER IN LAST 6 MOS.
YES
NO
HAVE YOU APPLIED FOR ANY NEW CREDIT CARDS OR FUNDING IN THE LAST 6 MOS.
YES
NO
DATE/TIME OF SUBMISSION
Gross monthly income
Monthly rent/mortgage
Comments
Consent
I understand that this quick questionaire is for pre-qualification purposes only and that a funding consultant can and will contact me to pre-qualify me for a Personal Loan / Gap Funding. I agree & consent to an Account Executives to reach out to me to discuss any potential concerns or questions I may have or to proceed with the full application to obtain formal approvals!
YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
YES
Appointment
Assigned Agent
David N. Rich
Andre Hardy
Eric Weidenbach
Tierra Smith
Tommie Murrie
Alex Ciarro
Endia Nelson
Johnathan Lloyd
Robin McLellan
HOW DID YOU HEAR ABOUT US
Send Application Now
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