Funding Intake Form

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.Make sure you are checking both your primary and other folder

example@example.com

3

Phone Number* This field is required.Please put your cell # as we will text & email you to schedule our call

Please enter a valid phone number.

4

How Much Are You Seeking?* This field is required.

6

What Is Your Experian Credit Score* This field is required.Please DO NOT give Credit Karma (yes we work with lenders that view other bureaus)

7

What Is Your Monthly Income* This field is required.This should match the amount going into your bank account (Put N/A if you don't have income/revenue)

Personal Income

Business Revenue

8

What Issues Do You Have on Your Credit Profile?* This field is required.We have programs that work with all credit issues and profiles

Charge Offs

Collections

Late Payments (last 10 months)

More than 4 Inquiries (the last 6 moths)

Bankruptcy

High Utilization

None

10

Do You Currently Have Offers You Are Considering* This field is required.We have the ability to beat any offer, we just need the official offer sheet

YESNO

11

When Is The Best Time For Our Call?* This field is required.These times are based on CST (Central)

9am-11am

12pm-2pm

3pm-5pm

Evenings or Weekends