All fields marked with an astrix (
*
) are required to submit and complete this assessment.
Company Name:
*
Type N/A if you don't have a business yet
Name:
*
First Name
Last Name
Company/Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
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Belize
Benin
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Bolivia
Bosnia and Herzegovina
Botswana
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Brunei
Bulgaria
Burkina Faso
Burundi
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Canada
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Chile
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Christmas Island
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
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The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
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Jordan
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Kiribati
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Laos
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Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
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United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number:
*
-
Area Code
Phone Number
E-mail:
*
Duns Number:
EIN Number:
Allied Representative
*
Please Select
Cherry Hendrix
David Jackson Jr.
Dominique Jackson
Kellie Rea
Vickie Stevenson
Walter Williams
Other
N/A
Funding is for your:
For Profit Business
Non Profit Business
Real Estate Investing
What is the structure of your business
Sole Proprietorship
Partnership
Limited Liability Company
C - Corporation
S - Corporation
Non - Profit
NA
Other
How many years has the business been in existence?
*
New Business
Less than 2 years
2 years or more
NA
Is This a Veteran Owned Business
*
Yes
No
Is This a Woman Owned Business
*
Yes
No
What is the Business type?
*
Service
Manufacturer
Wholesale
Retail
Restaurant
Hotel/Motel
Gas Station
Real Estate
Other
How many employees does the business have?
*
Include yourself as the owner
Credit & Financial Standing
What is your personal credit score?
*
721+
681 - 720
651 - 680
601 - 650
550 - 600
Do you know your Paydex Score?
*
Yes
No
What is a Paydex Score?
What is your Paydex Score?
*
80 or above
Below 80
Do you currently have any open personal trade-lines
*
Yes
No
What is your highest credit limit on an existing trade-line?
*
What is the business' estimated annual revenue?
*
Even Starts Ups need estimated annual revenue
What is the business' average monthly revenue over the last 3 months?
*
Type NA if not applicable
Is collateral available to support the loan?
*
Yes
No
Please provide the estimate dollar amount or value of the collateral
*
Please use a whole dollar amount.
Do you own a home?
*
Yes
No
Please provide the approximate amount of equity in the home.
*
Please use a whole dollar amount.
Do you own commercial property?
*
Yes
No
Please provide the approximate amount of equity in the property.
*
Please use a whole dollar amount.
Documentation and Support
Do you have a written Business Plan?
*
Yes
No
Do you have 3 to 5 years of financial projections?
*
Yes
No
Do you have Business Tax Returns?
*
Yes
No
Have you applied for a loan with a financial institution within the last three months?
*
Yes
No
Please provide a description of the current status of the business highlighting the reasons why you need financing.
*
Maximum 1000 characters
0/1000
Funding Needed
How much funding are you seeking?
*
Up to $25,000
Up to $50,000
Up to $100,000
Up to $250,000
Up to $500,000
Up to $1,000,000
Over $1,000,000
How will you use the money?
*
Purchasing Property
Buying equipment
Remodeling/Expansion
Refinancing debt
Hiring employees
Working capital
Purchasing inventory
Marketing
Buying an Existing Business
Other
Request for Services
Are you requesting assistance in producing a Business Plan with Financial Projections?
*
Yes
No
Are you requesting personal credit consulting services (to repair/establish) ?
*
Yes
No
Are you requesting business credit consulting services? (to build/establish)
*
Yes
No
Are you requesting Pre-loan technical assistance: Work with Allied’s experienced Access to Capital Consultants and staff to identify the needs of your business. Receive valuable recommendations specifically designed to meet your goals and position yourself to potentially receive financing for your business.
*
Yes
No
Are you requesting Post-loan technical assistance: Work with Allied's Access to Capital Consultant to evaluate the progress of reaching your business goals. Receive one-on-one business consultations and training in areas such as business development, marketing and more to help grow your business.
*
Yes
No
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