BUSINESS FUNDING QUESTIONNAIRE

Business Funding Questionnaire

Complete the Business Funding Questionnaire as thorough as possible to ensure we can provide maximum funding.
How much funding are you requesting?*
What type of funding are you looking for?*
BORROWER PERSONAL INFORMATION
Primary Contact Name*

PrefixFirst NameMiddle NameLast NameSuffix
Primary Contact Email*
example@example.com
Primary Contact Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
What is your Credit Score Range?*

720 or higher680-719620-679600-619580-599580 or belowOther
What's your personal source of provable income?*
Please select your personal source of income.*
Have you filed your personal taxes in the last 2 years?*
PERSONAL CREDIT REPORT

You must provide your tri-merge credit scores by selecting one of the credit monitoring services and providing us with the login credentials.
SELECT CREDIT REPORT MONITORING SERVICE
Credit Report Monitoring Username
Credit Report Monitoring Password
Credit Report Monitoring Pin, if applicable
Please provide Credit Report Monitoring security questions and answers.
Is there a Co-borrower? If yes, they must complete a separate application. Please indicate in the additional information section that you are a co-borrower for the borrower's name.*

YesNo
BUSINESS ENTITY INFORMATION
Business Legal Name*
Business trade name or DBA
If applicable
What is the legal structure of your business?*
Which state is your business in?*
How long have you been in business?*
Which industry is your business in?*
Business EIN*
What percentage (%) of the business do you own?*
What is your title at the business?*
CEO, Managing Partner, Director, etc.
Number of employees*
Briefly describe your business*
What is the Gross Annual Revenue for the business for last year?*
What is the Gross Annual Revenue for the business for previous year?*
Have you filed your taxes with the IRS for the last 2 years?
Are you currently in good standing as it relates to taxes with the IRS?
Please share any pertinent information regarding IRS status.
Members/Officers (List all members with 20% ownership or more)
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*

Area CodePhone Number
Eligibility Questions
Have You Ever Defaulted on a Government Loan? (i.e. SBA Loan, Student Loan, etc.)*

YesNo
Are the majority owners of the business US citizens or Legal Permanent Residents?*

YesNo
Have you exhausted all funding options?*

YesNo
In a paragraph please explain why you need funding. *
How will you using the funds: payroll, rent, inventory, etc.
Identification Verification

for Primary Contact
Upload Articles of Incorporation for your Business Entity

Browse Files

Cancelof
Upload Your Last 2 Years Personal Tax Returns

Browse Files

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Upload Your Last 2 Years of Business Tax Returns

Browse Files

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Upload an image of your valid Government Issued I.D.*

Browse Files
Driver's License, Passport Cancelof
Upload an image of the front and back of your Social Security Card*

Browse Files

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Upload the entire front page of your Utility Bill that verifies your personal address*

Browse Files
Your name must be listed as the account owner Cancelof
ADDITIONAL INFORMATION: Please share any additional pertinent information relative to this application.
Advisor Information
How did you hear about Jumpstart Capital Advisory Group?*
Thank you for providing responses. By submitting this application, you acknowledge that everything is true and correct to the best of your knowledge. Please note that due to very high volume, there may be some delays, and all applications are reviewed in the order in which they are received.

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Please verify that you are human*
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Business Funding Questionnaire

BORROWER PERSONAL INFORMATION

PERSONAL CREDIT REPORT

BUSINESS ENTITY INFORMATION

Eligibility Questions

Identification Verification

Advisor Information