New Customer Introduction Form

SHORT TERM BUSINESS LOANS

(These are not MCA loans!)
New Customer Introduction Form

(for Soft Terms only, please do not share an SSN or EIN on this form)
You Are Safe

We NEVER share your information with anyone other than our affiliated lenders. And we don't even do that until after we've spoken with you. This form is sent to our internal team only. We use it only to gain a picture of you and your needs. We will not share ANYTHING from it with ANYONE until AFTER we have spoken to you and gotten your authorization. This is NOT a data grab. This is an introduction.
Borrower Full Name*

First NameLast Name
Business Legal Name*
Business Industry
Mechanical, Manufacturing, Medical, Automotive, Professional Services, Accounting....
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Business E-mail*
Ok to text this number?

YESNO
Amount Requested*
MUST BE $15K OR HIGHER
Term Requested (months, 6-18)*
Average Monthly Gross Revenue*
Approx FICO*
*We are not asking for SSN or EIN, so no credit pull of any kind will happen.
Timeframe/Urgency*
Anything else you'd like us to know?
How Did You Find Us?*
Should be Empty:

SHORT TERM BUSINESS LOANS