AGFS - Questionnaire Form

Referral Code (if applicable)

If you were referred to AGFS, please input their full name or 10-digit Affiliate Partner ID# (If section does not apply, please input N/A)

Business Name*

Should match the name appearing on your formation documentation

Owner's Name*

First NameLast Name

Email Address*

This email may be used for future correspondence

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Input the state that your business operates out of*

AGFS offers their loan services nationwide. However, our grant opportunities are only available for NJ based businesses (we are working to expand our grant program services in the near future)

Which funding type are you interested in?*

LoanGrantBoth

If you already know which lending product you are interested in applying for, then please input the product type and confirm the use of funds.*

What industry are you in?

Number of employees*

This number should be consistent with your business tax filings

Provide a brief description of your business' operations*

Business formation date (mm/yyyy)*

Name of all owners or loan guarantors*

If you have 100% ownership in your business, then input N/A

Annual business revenue*

Personal credit score of business owner(s)*

Please provide a brief summary of any credit concerns appearing in your credit report*

What will you be using the funds for (vehicle purchase, cash flow, consolidation etc)?*

What is the desired funding amount you are seeking?*

Do you have any collateral?*

Business owner has a 401k or IRAAccounts receivable (money owed to the business by your B2B customers)Commercial real estate generating incomeCertificate of Deposit (CD)CryptocurrencyConsistent monthly business revenueStocks, bonds, treasuries or other securitiesNo collateral

More details about your business

In this section, we would like a deeper understanding of your business operations. AGFS will use this information solely for the purpose of determining whether there may be additional funding options available to you outside of Allie Grace Funding's database by constructing an enhanced view of your borrower profile. Understanding your overall financial stature will also enable us to establish a more precise timeline for securing funding

This section is optional, however, providing the following information could lead to a more accurate lending recommendation

Do you have an existing business plan in place?

YesNo

Which of the following business channels does your business operate from?

OnlineRetail Store (Physical Location)Both

Does your business operate on a seasonal basis, whereby revenue is generated primarily during a specific time of the year?

YesNo

Do you have a business checking account in your company's name?

YesNo

Do you work with a financial or legal professional to keep your business documentation current (e.g., Accountant, Attorney, Financial Advisor etc)?

YesNo

Are all of your business formation documents—such as your license, registration, and certificate of incorporation—readily accessible?

YesNo

If your company employs staff, is your payroll documentation—such as paystubs, payroll summary reports, WR-30 or IRS Form 941—readily accessible?

YesNo

Does your business currently use payroll software or work with a service provider like ADP, Gusto, or QuickBooks for payroll management?

Payroll softwareService providerFinance professionalOther

In the event that your business does not meet the eligibility requirements for a traditional business loan, would you be open to pursuing short-term financing options that may involve less favorable terms, including repayment periods of fewer than 24 months and elevated interest rates?

YesNo

If you do not receive a response from AGFS within 72 hours from the time of submission, please email support@myalliegrace.com to confirm your name, phone number, email address and completion date.

AGFS Lender Submission Form