Loan Pre-Qualification Form

Loan Pre-Qualification Form
Applicant/Owner Personal Information
Full Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
SSN
DOB*

MonthDayYear
Date
Fico Score (Avg Estimate)
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you learn about us? Referral / Affiliate's name or promo code?

Have you filed bankruptcy in last 10 years?

YesNo
Do you owe property taxes for the previous tax year?

YesNo
Do you have any judgements, claims, collections or lawsuits?

YesNo
Do you own or rent your primary residence?

OwnRent

Business Information
Business Entity Type?

LLCCorp/S-CorpSole ProprietorshipPartnership
Legal Business Name*
Doing Business As (DBA) if different from business name
Type of Business*
EIN Number or Tax Number*
Business Phone Number*
Please enter a valid phone number.
Business Address (No PO Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Start Date

MonthDayYear
Date
Business Website
For any business that uses memberships to generate revenue (e.g., gyms, trade orgs, clubs, religious, school, subscription services):

Please provide your organization’s membership figures over the past four years:

Total Members = All active members in the organization.
Paying Members = Members who pay dues, fees, subscriptions, or similar.

Memberships (count)

	YTD (Year To Date)	Last Year	Two Years Ago	Three Years Ago
Total Membership
Paying Membership

Owner #1 Name*

First NameLast Name
Owner #2 (if applicable)

First NameLast Name
Website
Monthly Revenue
Annual Revenue
Desired Loan Amount
When are funds needed?
Purpose or Use of Funds?
Do you have a Business Checking Account?

YesNo
Do you have any outstanding Loans?
Describe any additional income or source of funds not already provided? W2?
Do you accept more than 50% of your sales on credit or debit card?

YesNo
Do you Rent or Own your Business Building?

RentOwn
Business Landlord (if renting)
Business Landlord Phone # (If renting)

Owner #2 Information (If applicable)
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
SSN Number
Home Address (No PO Box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you filed bankruptcy in last 10 years?

YesNo
Do you owe property taxes for the previous tax year?

YesNo
Do you have any judgements, claims, collections or lawsuits?

YesNo
Do you own or rent your primary residence?

OwnRent

For Real Estate loans #1 (If applicable)
Property Address #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchase Price
Estimated Property Value
Requested Loan
Property will be held in name of
Provide any additional information that can be used towards this RE request #1
For Real Estate loans #2 (If applicable)
Property Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchase Price
Estimated Property Value
Requested Loan
Property will be held in name of
Provide any additional information that can be used towards RE request #2

Attach last 6 months of Bank Statements (If applicable)

Cancelof
Attach Credit Bureau reports (If applicable)

Cancelof
Additional documents

Cancelof
Provide any additional information that could support your application
Owner/Applicant #1 Signature*

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Date*

MonthDayYear
Date
Owner/Applicant #2 Signature (If applicable)

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Date

MonthDayYear
Date
Should be Empty: