Funding Client Intake Form

Funding Client Intake Form

Please fill out all information completely and accurately to prevent delays.

Requirements:

700 credit score
No derogatories, no collections, no late payments within last 2 years.
Less than 20% utilization
Less than 3 inquiries( but we can remove if needs)
Credit cards 6months or older

***Please keep in mind our fee for funding is 10% fee of the total amount funded. Ex. Client is secured $100,000. Our Fee is $10,000

Type of funding are you looking to obtain?
Credit Score
Personal Information
Full Name

First NameMiddle InitalsLast Name
Personal Email Address*
Phone Number*
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Identity Verification
Social Security Number
Mother's Maiden Name*
Driver's License Information
Driver's License Number*
Driver's License Issued State*
Driver's License Issue Date*

MonthDayYear
Driver's License Expiration Date*

MonthDayYear
Employment Information
Name of Employer*
(if self employment mark n/a and continue)
Employer Phone Number*
(if it doesn't apply mark n/a)
Employer Address (if it doesn't apply mark n/a)*
Current Job Title*
Years in Current Position?*
(if it doesn't apply mark n/a)
Total Household Annual Income*
Personal Credit Monitoring
Credit Karma User Name*
Credit Karma Pass*
Experian.com User Name*
Experian.com Pass*
Business Information
Business Formation Type*

LLCS CorpC ScorpNonProfitSole Prop
Business Name
Business Phone Number
Business Address
Business Email
example@example.com
Business Established Date

MonthDayYear
Business Website
Dunns Number
Ein Number
Business Bank Accounts Currently Open
NAV.com User Name (Business Scores)
NAV.com Pass (Business Scores)
Business Credit Cards Currently Open
Business Credit Lines Currently Open
Business Total Annual Revenue
Funding
Select Financial Documents you can prove if banks ask

Verifiable Check Stubs2 Years of Personal Tax Returns2 Years of Business Tax ReturnsBusiness Bank StatementsPersonal Bank Statements3 months of a current Business Credit card statementI'm looking to try the no documentation program
How much funding are you seeking?

$10k-$50k$50k-$100k$100k-$250k$250k+
Referred By?
Should be Empty: