Loan Readiness Questionnaire

Loan Readiness Questionnaire

Answering the questions below is the first step to determine if you are eligible for our Loan Readiness program, but does not guarantee acceptance. We take your confidentiality seriously, so we are entrusting Jotform.com to help us collect and protect your data. To learn more: https://www.jotform.com/enterprise/security/
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What is the best method of contacting you?

EmailTelephone
Are you already a client of West Business Development Center?

YesNoUnsure
What is the loan amount that you are seeking?

$1,000 to $25,000$25,001 to $50,000$50,001 to $250,000$250,001 or more
Do you have collateral to pledge for this loan (what will be forfeited in the event of a default)?

YesNoUnsure
Approximate value of collateral $.
How will you use the funds?

Start a businessAcquire a businessBuy a buildingRefinance existing debtPurchase machinery or equipmentPurchase inventoryRegular operating expensesOther
When will you need the funds?

1 to 2 months2 to 4 months4 + monthsJust researching, no immediate need
What is the name of your business?
What is your current legal business structure?

Sole ProprietorshipLimited Liability CompanyCorporation (S or C)Non-ProfitNo Legal Structure Yet
Do you have a written business plan?

YesNo
Personal Credit Score

Tell us about your relationship with credit and payments.

	Yes	No
Paid your credit card late within the last year?
Had any collections within the last three years?
Had any repossessions within the last three years?
Do you owe child support?
If applicable, are you current on child support payments?
Had any overdrafts or insufficient funds on your bank statement within the last 3 months?
Any bankruptcies within the last 3 years?

I currently owe on my current (loan #1) $ blanks and my monthly payment is $blank .
I currently owe on my current (loan #2) $ blanks and my monthly payment is $blank .
I currently owe on my current (loan #3) $ blanks and my monthly payment is $blank .
I currently owe on my current (loan #4) $ blanks and my monthly payment is $blank .
Anything else you would like to convey to us or any clarifications to any of your responses above? If no, leave blank.
Were you referred to us by someone at a lending institution? If yes, please provide the name of the person and the name of the lending institution. If no, leave blank.
Should be Empty: