Lending Intake Form

Lending Intake Form

Provide your details to start the lending process.
Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Requested Loan Amount
Purpose of Loan
Employment Status
Monthly Income (USD)
Additional Comments
Applicant Information
First Name
Last Name
Percent Ownership (%)
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip Code
Date of Birth (MM/DD/YYYY)

MonthDayYear
SSN
Best Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Estimated FICO Score
Press Submit After You Sign With Your Finger on Mobile
Our Business Loans, Working Capital, and Lines of Credit Fund Same and Next Day. The information is only transmitted to the owner of Us Trust.
Business Information
Legal Business Name
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip
Business Start Date (MM/DD/YYYY)

MonthDayYear
Date
Business Financial Information
EIN#
Purpose of Funds
Requested Funding Amount
When is the money needed?
How Did You Hear About US Trust?
Have You Slow Paid or Defaulted On Any Business Loans or Advances?
Last 4 Months Bank Statements
Last 4 Months Bank Statements

Upload the last 4 months of bank statements.
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Sign With Your Finger or Mouse
Certification and Authorization to Verify Information

By signing below, I certify that I am an authorized representative of the business named above and that all information and financial documents provided are true and accurate to the best of my knowledge.

I hereby authorize Providential Growth Solutions (a division of Finance Your Care of Alabama, LLC) and its designated lending partners to review these documents for the purpose of evaluating this funding request. I understand that Providential Growth Solutions acts as a strategic intermediary and that this submission does not constitute a guarantee of funding. I further authorize the verification of business information as necessary to provide a preliminary funding decision.
Should be Empty:

Lending Intake Form

Applicant Information

Business Information

Business Financial Information

Last 4 Months Bank Statements