AGFS - Questionnaire Form

AGFS Lender Submission Form

Please do not leave any fields blank
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.
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*
Annual business revenue*
Personal credit score of business owner(s)*
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
If you do not receive a response from AGFS within the next 72 hours, please email us at support@myalliegrace.com to confirm your name, phone number & email address.
Should be Empty:

AGFS Lender Submission Form