Business/Personal Funding Form
Name
*
First Name
Last Name
Mother Maiden Name
*
Personal Email
*
example@example.com
Business Email
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What type of funding are you looking to obtain?
*
Personal
Business
Both
What is your credit score?
*
600 or below
601-680
681-760
761+
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What is your monthly income?
*
Are you a US Citizen?
*
Yes
No
Are you in Chex Systems?
*
Yes
No
I'm not sure
Do you have any late payments, collections, or anything that is derogatory on open/ closed accounts?
*
Yes
No
I'm not sure
Are you in Early warning Services?
*
Yes
No
I'm not sure
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Do you have an Active LLC?
*
Yes
No
Current Personal Mailing Address
*
Business Address/ Mailing address
*
Registered Business Name
*
If yes, what industry/ NAICS code is it registered under
*
If no, what type of business are you looking to start?
*
If yes, how old is your LLC?
*
Less than a year
1 year
2 years
3+ Years
Current Business Description or what business you want to start?
*
Number of Employees (You count as 1)
*
What is you Ownership Percentage?
*
What is your annual Business Revenue?
*
How long have you been in business?
*
Personal Annual income?
*
Do you have two years Business tax returns?
2023 Business Tax return
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2024 Business Tax return
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2025 Business Tax return
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Year-to-Date Profit & Loss Statement
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What State did you Incorporate your LLC in?
*
Do you have an Active Business Checking and Savings account with Chase, Bank of America and US bank?
*
Chase
Us Bank
Bank of America
None
Do you have an Active Personal Checking and Savings account with Chase, Bank of America and US Bank?
*
Chase
US Bank
Bank of America
None
Do you have any Business Credit Cards?
*
Yes
No
If yes, which Business Credit Cards/ lines do you have and what are the balances/limits
*
When were these Business Credit Cards/ lines opened?
*
Have you or the Business ever Filed Bankruptcy?
*
I have filed Bankruptcy before, but my Company has not
My company has filed Bankruptcy before, but I have not
I have not filed for bankruptcy nor has my business
Have you requested your LexisNexis Consumer Disclosure Report?
*
Yes
No
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EIN Document
*
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Business Lease Agreement
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Operating Agreement (Signed)
*
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Articles of Incorporation
*
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Corporate Bylaws
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SBSS(Fico) screenshot (Found on Nav prime $75 a month membership)
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Certificate of Good Standing for Company can be found from state website
*
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Utility bill/ Mail with current mailing address
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SSN copy
*
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Front Driver's License
*
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Copy of your back Driver License
*
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Last 3 months paystubs here
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Employer details (Start date, Position, phone number)
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How much funding are you seeking?
*
$10k- $50k
$50k- $100k
$100k-$250k
$250k+
Referred By?
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