Business Credit & Funding Readiness Intake

Business Credit & Funding Readiness Intake

Complete this intake to request a Business Credit & Funding Readiness Review—share your business details, credit history, and funding goals (no sensitive identity or account access required).
Contact Information
First Name
Last Name
Business Title / Role
Company Name
Best Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address
example@example.com
Preferred Contact Method
Relationship to Business
Business Identity
Legal business name
DBA / trade name
Entity type
State of formation
Country of formation
Formation date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
EIN status
Employer identification number
Industry
NAICS code (optional if unknown)
Business Location and Online Presence
Business street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State / Province
Postal code
Country
Business phone
Please enter a valid phone number.Format: (000) 000-0000.
Business website / domain
Business email
example@example.com
Ownership and Company Profile
Ownership structure

Other
Owner name

First NameMiddle NameLast Name
Percentage ownership
Time in business (years)
Year started
Average monthly revenue
Average monthly deposits
Banking History
Does the business currently have business bank accounts?
How many business bank accounts does the business have?
Primary bank or banks
Approximate length of banking relationship
Typical average balance range
Any overdrafts or returned items in the past 12 months?
Willing to discuss bank statements or banking history during review?
Existing Business Credit and Trade Profile
Existing business credit accounts

Other
D-U-N-S number status
Business credit bureau profiles

Other
D-U-N-S number
Business credit score (Experian Business)
Business credit score (Dun & Bradstreet)
Business credit score (Equifax Business)
Any late payments in the past 12 months
Any collections, liens, judgments, or bankruptcies
Brief details on late payments or credit issues
Additional trade profile notes
Funding and Service Needs
Primary funding goal
Requested funding amount
Intended use of funds

Other
Funding timeline
Vendor and trade credit needs

Other
Fleet needs

Other
Equipment needs

Other
Bookkeeping and accounting status
Requested services from our firm

Other
Consent, Privacy, and Document Uploads
Consent to be contacted by phone, email, and text
Privacy acknowledgement
Understanding of outcome disclaimer
Willingness to provide supporting business documents
Upload non-sensitive business documents
Consent and acknowledgement
Final request to review
Should be Empty:

Business Credit & Funding Readiness Intake

Contact Information

Business Identity

Business Location and Online Presence

Ownership and Company Profile

Banking History

Existing Business Credit and Trade Profile

Funding and Service Needs

Consent, Privacy, and Document Uploads