Business Information
Business Name
*
Years in Business
*
Please Select
Less than 1 year
1–2 years
3–5 years
5+ years
Business Industry
*
Monthly Revenue
*
Please Select
Below $10K
$10K–$50K
$50K–$100K
$100K+
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Funding Details
Requested Loan Amount
*
Please Select
$10K–$50K
$50K–$100K
$100K–$250K
$250K+
Purpose of Funding
*
Please Select
Working Capital
Equipment Purchase
Business Expansion
Debt Refinance
Other
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Contact Details
Full Name
*
Email
*
Phone Number
Please enter a valid phone number.
Address
Consent
*
I confirm the information provided is accurate and authorize The Lana M Group or its lending partners to contact me.
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