Heter Iska
Intake Form
Name
*
First Name
Last Name
Company Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please provide a brief description of these funds/loan.
*
What are the names of the parties involved? Please specify who is the lender and who is the borrower.
*
Lender
Borrower
Is this a loan (that the money must be returned regardless) or an investment (that there stands a risk of loss to the principal)?
*
Please Select
Loan
Investment
What is the principal amount of the loan?
*
What is the interest rate?
*
Will the borrower be using the loan for a business venture/investment or for personal needs?
*
Please Select
business venture/investment
personal needs
Does the borrower have personal assets and/or investments?
*
Please Select
Yes
No
I don't know
Submit
Should be Empty: