Loan Pre-Qualification Form

Loan Pre-Qualification Form

Loan Pre-Qualification Form
Applicant/Owner Personal Information
Full Name

First NameLast Name
Email

Confirmation Emailexample@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SSN (Social Security Number)
DOB

MonthDayYear
Date
Residency / Legal Status

Other (please specify)
Fico Score (Avg Estimate)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you learn about us? Referral / Affiliate's name or promo code?

Have you filed bankruptcy in last 10 years?
Do you owe property taxes for the previous tax year?
Do you have any judgements, claims, collections or lawsuits?
Do you own or rent your primary residence?

Business Information
Business Entity Type?

Other
Legal Business Name
Doing Business As (DBA) if different from business name
Type of Business
EIN Number or Tax ID 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

CityState / Province

Postal / Zip Code
Business Start Date

MonthDayYear
Date
Business Website
Business Social Media link(s)
For any business that uses memberships to generate revenue (e.g., gyms, trade orgs, clubs, religious, school, subscription services):

Please provide your organization’s membership figures over the past four years:

Total Members = All active members in the organization.
Paying Members = Members who pay dues, fees, subscriptions, or similar.

Memberships (count)

Rows	YTD (Year To Date)	Last Year	Two Years Ago	Three Years Ago
Total Membership
Paying Membership

Owner #1 Information

First NameLast Name
Owner #2 (if applicable)

First NameLast 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?
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?
Do you Rent or Own your Business Building?
Business Landlord (if renting)
Business Landlord Phone # (If renting)

Owner #2 Information (If applicable)
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
SSN Number
Home Address (No PO Box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you filed bankruptcy in last 10 years?
Do you owe property taxes for the previous tax year?
Do you have any judgements, claims, collections or lawsuits?
Do you own or rent your primary residence?

For Real Estate loans #1 (If applicable)
Property Address #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchase Price
Repairs Cost (if applicable)
Estimated Property Value
Requested Loan
Property will be held in name of
Provide any additional information that can be used towards this RE request #1
For Real Estate loans #2 (If applicable)
Property Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchase Price
Estimated Property Value
Requested Loan
Property will be held in name of
Provide any additional information that can be used towards RE request #2

Attach last 6 months of Bank Statements (If applicable)

Cancelof
Attach Credit Bureau reports (If applicable)

Cancelof
Additional documents (2 years Business Tax Returns, Driver License, Company Brochure, etc..)

Cancelof
Provide any additional information that could support your application
Owner/Applicant #1 Signature
Date

MonthDayYear
Date
Owner/Applicant #2 Signature (If applicable)
Date

MonthDayYear
Date
Should be Empty: