Southern Gate Capital - Client Pre-Qualification Form
(Secure & Confidential - No hard credit check)
Name
First Name
Last Name
Business Name
Business Start Date
Monthly Revenue
Estimated Credit Score
500 or below
501-600
601-650
651-700
701-749
750+
Industry
Business Entity Type
Please Select
LLC
Sole Proprietor
Corporation
Partnership
Email
example@example.com
Phone Number
Please enter a valid phone number.
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Requested Funding Amount
Use of Funds
Working Capital
Equipment
Inventory
Expansion
Marketing
Emergency
Other
I certify that the information provided is accurate and complete to the best of my knowledge.
Submit
Submit
Should be Empty: