Business Funding Qualification Questionnaire

Referral Partner Full Name(if applicable)

First NameMiddle NameLast Name

Referral Partner Email

example@example.com

Referral Partner Phone

Please enter a valid phone number.Format: (000) 000-0000.

Business Owner / Investor Full Name

First NameLast Name

Co-Owner(if applicable)

First NameLast Name

Business Name

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Phone

Please enter a valid phone number.Format: (000) 000-0000.

Business Email

example@example.com

Business Industry

State

SSN

Co-Owner SSN

How much funding do you need?

What is the funding needed for?

If "Other," please describe

How long has the business been operating?

What is the owner's estimated Equifax credit score?

Does the business currently have any outstanding Merchant Cash Advances(MCAs)or other loans?

If yes, how many outstanding MCAs?

Approximate average monthly revenue

Best time to reach you

Applicant Signature Box

Co-Applicant Signature

Capital Funding Group:Business Funding Application