Frankly Pre-Qualification Form

1
How much money does your business need?* This field is required.
$5,000 - $10,000
$10,000 - $20,000
$20,000 - $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
2
Country
CA
Please Select
USA
CA
3
Funds Requested
4
Lead Source
Frankly Funding
Please Select
Frankly Funding
5
CRM Company
Please Select
Please Select
Frankly Funding
6
Device
7
Do you currently have a Business Bank Account?Yes, I have a Business Bank Account / No, I have a Personal Bank Account
YESNO
8
Business Bank Account
9
Select your Business Type:
Sole Proprietor
Partnership
Limited Liability Company (LLC)
S Corporation
C Corporation
10
Business Type
11
What do you need the financing for?Select and click "Next >" to continue
Please Select
Please Select
Start a new Business
Open a New Location
Advertising / Marketing
Equipment
Buyout A Partner
Supplies / Inventory
Hire Additional Staff
Get Me Through A Slow Period
Remodeling / Upgrading Location
Have In The Bank
Other Use Of Funds
12
How long have you been in business?
Less than 6 months
6 - 12 months
1 - 2 years
2 - 5 years
5 + years
13
Time in Business
14
What's your credit score?
Excellent > 720
Good 680 - 719
Fair 551 - 679
Poor < 550
15
Credit
16
What is your current monthly revenue?* This field is required.(Revenue and Bank Deposits will be verified later in the process. Please try and be accurate.)
$0 - $5,000
$5,000 - $10,000
$10,000 - $20,000
$20,000 - $30,000
$30,000 - $40,000
$40,000 - $50,000
$50,000 - $60,000
$60,000 - $70,000
$70,000 - $80,000
$80,000 - $90,000
$90,000 - $100,000
$100,000+
17
Monthly Revenue
18
What's the name of your business?* This field is required.
19
What industry are you in?Select and click "Next >" to continue
Please Select
Please Select
Automotive Repair
Automotive Sales
Automotive Gas Station
Dental
Physician
Chiropractor
Optometrist
Veterinary
Home Health Care Service
Furniture
Electronics
Grocery
General Merchandise
Clothing
Home Furnishing
Hardware
Jewelry
Food/Health Care
Gift
Sporting Goods
Plumbing/HVAC Contractors
Cleaning Services (B2B)
Cleaning Services (B2C)
Contractors
Landscaping
Nail Salon
Beauty Salon
Bar
Bar/Restaurant
Hotel/Motel
Beer/Wine/Liquor Distributor
Other
20
Industry
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What's your name?* This field is required.
First Name
Last Name
22
Email* This field is required.
example@example.com
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utm_campaign
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utm_medium
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utm_source
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utm_term
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utm_content
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ttclid
29
Inquiry Name
30
Date
Date
Month
Day
Year
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Hour
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Minutes
31
Phone* This field is required.
Please enter a valid phone number.
32

Sorry but at this moment you don't qualify for the funding process!
Should be Empty: