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Business Funding GPA
1
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2
What Type Of Business Do You Own?
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LLC
Partnership
S-Corp
C-Corp
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3
Do You Have A Business Bank Account?
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YES
NO
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4
What Will The Funds Be Used For?
*
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Please Select
Business Working Capital
Debt Refinance
Expansion
Hire Staff
Inventory
New Location
Partner Buyout
Payroll
Product Development
Equipment
Marketing
Taxes
Training
Please Select
Please Select
Business Working Capital
Debt Refinance
Expansion
Hire Staff
Inventory
New Location
Partner Buyout
Payroll
Product Development
Equipment
Marketing
Taxes
Training
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5
Which Is Most Important To You?
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Getting Cash Fast
Amount Of Funds
Rates & Terms
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6
How Long Have You Been In Business?
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Less Than 6 Months
6 months- 1 Year
1-3 years
3- 5+ years
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7
What Industry Is Your Business In?
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Please Select
Agriculture, Forestry, Fishing and Hunting
Arts, Entertainment, and Recreation
Adult Entertainment
Gambling
Automobile Dealers & Parts
Construction
Ecommerce
Education
Finance and Insurance
Healthcare
Social Assistance
IT, Media, or Publishing
Legal Services
Mining (except Oil and Gas)
Oil and Gas Extraction
Manufacturing
Political, Governmental, or Public Organizations
Real Estate
Religious Organizations
Restaurants and Food Services
Retail Stores
Firearm Sales
Gas Stations
Transportation and Warehousing
Freight Trucking
Travel Agencies
Utilities
Wholesale Trade
All Other
Please Select
Please Select
Agriculture, Forestry, Fishing and Hunting
Arts, Entertainment, and Recreation
Adult Entertainment
Gambling
Automobile Dealers & Parts
Construction
Ecommerce
Education
Finance and Insurance
Healthcare
Social Assistance
IT, Media, or Publishing
Legal Services
Mining (except Oil and Gas)
Oil and Gas Extraction
Manufacturing
Political, Governmental, or Public Organizations
Real Estate
Religious Organizations
Restaurants and Food Services
Retail Stores
Firearm Sales
Gas Stations
Transportation and Warehousing
Freight Trucking
Travel Agencies
Utilities
Wholesale Trade
All Other
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8
Is Your Business Net- Profitable
*
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YES
NO
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9
How Much Revenue Did You Deposit In Your Business Bank Account Last Month?
*
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Under $10,000
$10,000- $20,000
$20,000- $50,000
$50,000- $100,000
$100,000+
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10
What Is Your Average Business Revenue Over The Last 3- Months?
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Average rev over the last 3 months
Please Select
Under $10,000 per month
$10,000- $20,000 avg per month
$20,000- $50,000 avg per month
$50,000- $100,000 avg per month
Over $100,000 average monthly rev
Please Select
Please Select
Under $10,000 per month
$10,000- $20,000 avg per month
$20,000- $50,000 avg per month
$50,000- $100,000 avg per month
Over $100,000 average monthly rev
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11
What Is Your Average Business Revenue Over The Last 3- Months?
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Under $10k
$10k- $20k
$20k- $50k
$50k- $100k
$100,000+
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12
Over The Last 3 Months, How Many Negative Balance Days Have You Had?
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Business Account Only*
No Negative Days
1-3 Negative Days
3- 5 Negative Days
5- 10 Negative Days
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13
What Is Your Current Credit Score?
*
This field is required.
Under 500
500-599
600-699
700+
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14
Do You Have Any Business Loans Being Paid Back On A Daily Or Weekly Basis?
*
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YES
NO
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15
Have You Ever Defaulted On A Business Loan?
*
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YES
NO
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16
Name
*
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First Name
Last Name
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17
What Is The Name Of Your Company?
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18
Best Email
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example@example.com
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19
Please Enter Your Phone Number
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20
When Is The Best Time To Reach You?
Morning
Afternoon
Evening
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21
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