Business Funding-Credit Assessment
Business Information
Business Name
Business DBA (if different).
Business Start Date?
Business Entity Type?
Sole Proprietor
LLC
S-Corp
C-Corp
Nonprofit
Other
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State of Incorporation
Industry
Date of Incorporation
Owner Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth?
Last 4 digits of Social Security Number
For soft credit pull.
Do you have a business partner or co-owner?
Yes
No
Credit & Financial Snapshot
Estimated Business Revenue
Monthly or Annual
Estimated Credit Score
500-599
600-649
650-699
700-749
750+
Do you have any active business credit cards or lines of credit?
Yes
No
Are you behind on any business or personal debts?
Yes
No
Are there any MCA (Merchant Cash Advance) loans or daily/weekly debits coming out of your account?
Yes
No
I'm not sure
Do you have any recent bankruptcies, liens, or judgments?
Yes
No
What would you like funding for?
Working capital
Consolidate Existing Debt
Equipment
Acquire Real Estate
Marketing or Expansion
Other (describe)
How much funding are you seeking?
$5K-$K25
$25K-$50k
$50k-$100k
$100k+
When do you need the funds?
ASAP
1-2 Weeks
30 Days
Just Exploring Options
Docs & Next Steps
Do you have any of the following ready to upload?
3-6 months business bank statements
Business tax returns
Profit & Loss Statement
Debt Schedule
None yet
Anything you would like to add:
File Upload
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PDF, JPG, XLS.
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I consent to be contacted via phone, text and/ or email by AffluentCF & Rockfish Management, LLC.
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