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11
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1
What do you need funding for?
*
This field is required.
Funding Purpose
Please Select
Additional Capital
Equipment Purchase
Expansion
Inventory
Marketing
Other
Payroll
Real Estate Purchase
Resolving Debt
Please Select
Please Select
Additional Capital
Equipment Purchase
Expansion
Inventory
Marketing
Other
Payroll
Real Estate Purchase
Resolving Debt
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2
How much funding are you requesting?
*
This field is required.
Funding Amount Requested
Please Select
$0-$5,000
$5,000-$10,000
$10,000-$25,000
$25,000-$50,000
$50,000-$75,000
$75,000-$100,000
$100,000-$200,000
$200,000 plus
Please Select
Please Select
$0-$5,000
$5,000-$10,000
$10,000-$25,000
$25,000-$50,000
$50,000-$75,000
$75,000-$100,000
$100,000-$200,000
$200,000 plus
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3
What is your average monthly revenue?
*
This field is required.
Average Monthly Revenue
Please Select
$0
1,000-5,000
$5000,$10,000
$10,000-$15,000
$15,000-25,000
$25,000-$50,000
$50,000-75,000
$75,000-$100,000
$100,000-$200,000
$200,000 plus
Please Select
Please Select
$0
1,000-5,000
$5000,$10,000
$10,000-$15,000
$15,000-25,000
$25,000-$50,000
$50,000-75,000
$75,000-$100,000
$100,000-$200,000
$200,000 plus
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4
What is your Credit Score Range?
*
This field is required.
Credit score is NOT a major factor in determining approval.
720 or higher
680-719
620-679
600-619
580-599
580 or below
Foreign National, No Score
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5
How long have you been in business?
*
This field is required.
Please Select
Startup
Under 6 months
6-12 months
1-2 years
2-4 years
Over 4 years
Please Select
Please Select
Startup
Under 6 months
6-12 months
1-2 years
2-4 years
Over 4 years
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6
Have you defaulted on a business loan in the past?
*
This field is required.
YES
NO
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7
Do you have a Business Checking account?
*
This field is required.
YES
NO
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8
Business Name
*
This field is required.
Business Name
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9
Primary Contact Name
*
This field is required.
First Name
Last Name
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10
Primary Contact Phone Number
*
This field is required.
Phone Number
Area Code
Phone Number
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11
Primary Contact Email
*
This field is required.
Email
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