CFS Prequalification Form

FUNDING PREQUALIFICATION FORM
Desired Funding Solution:*
What type of funds are you needing?
CONTACT INFORMATION
Business Legal Name:*
Business DBA (if applicable):
Business Phone:*
Please enter a valid phone number
Business Fax
Please enter a valid fax number.
Website:
Email:*
example@example.com
Physical Address:*

Address

Street Address Line 2

CityState

Zip
Mailing Address:

Address

Street Address Line 2

CityState

Zip
BUSINESS INFORMATION
Legal Entity (select one):*

CorporationLLCPartnershipLPLLPSole Proprietorship
Business Start Date:*

MonthDayYear
Date
Federal Tax ID:
Home Based Business?

YESNO
Open Judgements/Liens?

YESNO
Open Bankruptcies?

YESNO
State of Inc/LLC:*
Business Description:*
Industry Type (SIC Code):
Business Rent/Mortgage Information:

Rented/LeasedMortgaged
Monthly Rent/Lease/Mortgage Payment:
Remaining Term for Rent/Lease:
Payment Current?

YESNO
Landlord/Mortgage Company Contact:
Contact Phone:
FUNDING INFORMATION
Amount Requested:
When Are Funds Needed:

ASAP30 Days60+ Days
Desired Use of Funding Proceeds:
Gross Annual Sales:
Gross Monthly Sales:
Monthly Credit Card Volume:
Current Cash Balance:

YESNO
Cash Advance/Loan Balance:
Current Credit Card Processing Company:
Account Number:
OWNER/PRINCIPAL INFORMATION
First Name:*
MI:
Last Name:*
Title:
% Ownership:*
Home Address:*

Address

Street Address Line 2

CityState

Zip
Home Phone:
Mobile Phone:*
Please enter a valid phone number.
Date of Birth:*

MonthDayYear
Date
SS#:
Social Security Number
CO-OWNER/PRINCIPAL INFORMATION
First Name:
MI:
Last Name:
Title:
% Ownership:
Home Address:

Address

Street Address Line 2

CityState

Zip
Home Phone:
Mobile Phone:
Date of Birth:

MonthDayYear
Date
SS#:
Social Security Number
FINANCED PROPERTY INFORMATION
Property Address

Street Address

Street Address Line 2

CityState

Zip Code
Property Type:

Single Family (1-4 Units)Multifamily (5+ Units)CommercialLand
Loan Type

PurchasePurchase+RehabGround Up ConstructionRefinance
Purchase Price:
Present Value:
Rehab/Construction Cost:
After Rehab Value:
Date Acquired:

MonthDayYear
Date
Refinance Current Balance:
Existing Liens - Lender:
Total Loan Amount Requested:
Cash Out Needed:
Cash Out Use:
AUTHORIZATION
Owner Signature:

Clear
Printed Name:
Owner/Principal's Full Name
Date:

MonthDayYear
Date Owner Signed
Co-Owner Signature:

Clear
Printed Name:
Co-Owner/Principal's Full Name
Date:

MonthDayYear
Date Co-Owner Signed
Should be Empty:

CONTACT INFORMATION

BUSINESS INFORMATION

FUNDING INFORMATION

OWNER/PRINCIPAL INFORMATION

CO-OWNER/PRINCIPAL INFORMATION

FINANCED PROPERTY INFORMATION

AUTHORIZATION