Allied's Access to Capital Assessment

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 NameLast Name
Company/Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
E-mail:*
Duns Number:
EIN Number:
Allied Representative*
For Profit BusinessNon Profit BusinessReal Estate Investing
Sole ProprietorshipPartnershipLimited Liability CompanyC - CorporationS - CorporationNon - ProfitNAOther
New BusinessLess than 2 years2 years or moreNA
YesNo
YesNo
ServiceManufacturerWholesaleRetailRestaurantHotel/MotelGas StationReal EstateOther
How many employees does the business have? *
Include yourself as the owner
Credit & Financial Standing
721+681 - 720651 - 680601 - 650550 - 600
YesNoWhat is a Paydex Score?
80 or aboveBelow 80
YesNo
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
YesNo
Please provide the estimate dollar amount or value of the collateral*
Please use a whole dollar amount.
YesNo
Please provide the approximate amount of equity in the home.*
Please use a whole dollar amount.
YesNo
Please provide the approximate amount of equity in the property.*
Please use a whole dollar amount.
Documentation and Support
YesNo
YesNo
YesNo
YesNo
Please provide a description of the current status of the business highlighting the reasons why you need financing.*

Maximum 1000 characters0/1000
Funding Needed
Up to $25,000Up to $50,000Up to $100,000Up to $250,000Up to $500,000Up to $1,000,000Over $1,000,000
Purchasing PropertyBuying equipmentRemodeling/ExpansionRefinancing debtHiring employeesWorking capitalPurchasing inventoryMarketingBuying an Existing BusinessOther
Request for Services
YesNo
YesNo
YesNo
YesNo
YesNo
Should be Empty:

Credit & Financial Standing

Documentation and Support

Funding Needed

Request for Services