Credit Pre-Qualification Form
Applicant/Owner Personal Information
Full Name
*
First Name
Last Name
Email
*
Confirmation Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
SSN
DOB
*
-
Month
-
Day
Year
Date
Fico Score (Avg Estimate)
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Have you filed bankruptcy in last 10 years?
Yes
No
Do you owe property taxes for the previous tax year?
Yes
No
Do you have any judgements, claims, collections or lawsuits?
Yes
No
Do you own or rent your primary residence?
Own
Rent
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Next
Business Information
Business Entity Type?
LLC
Corp/S-Corp
Sole Proprietorship
Partnership
Legal Business Name
*
Doing Business As (DBA) if different from business name
Type of Business
*
EIN Number or Tax Number
*
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address (No PO Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Start Date
-
Month
-
Day
Year
Date
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Owner #1 Name
*
First Name
Last Name
Owner #2 (if applicable)
First Name
Last Name
Website
Monthly Revenue
Annual Revenue
Desired Loan Amount
When are funds needed?
Purpose or Use of Funds?
Do you have a Business Checking Account?
Yes
No
Do you have any outstanding Loans?
Describe any additional income or source of funds not already provided? W2?
Do you accept more than 50% of your sales on credit or debit card?
Yes
No
Do you Rent or Own your Business Building?
Rent
Own
Business Landlord (if renting)
Business Landlord Phone # (If renting)
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Owner #2 Information (If applicable)
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
SSN Number
Home Address (No PO Box)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you filed bankruptcy in last 10 years?
Yes
No
Do you owe property taxes for the previous tax year?
Yes
No
Do you have any judgements, claims, collections or lawsuits?
Yes
No
Do you own or rent your primary residence?
Own
Rent
Back
Next
Optional -Attach last 6 months of Bank Statements (PDF)
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Optional - Attach Credit Bureau reports
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Optional - Additional documents
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Optional: Provide any additional information that could support your application
Owner #1 Signature
*
Owner #2 Signature (If applicable)
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: