FullyFundable Business Loan Inquiry

BUSINESS FUNDING INQUIRY/ASSESSMENT

(no credit pull or documentation necessary at this phase)
** PLEASE NOTE ** Information entered within this form will be shared with a minimum number of select lending partners and/or associates of FullyFundable for review, assessment, and consultative purposes.

FullyFundable makes best efforts to ensure your information will not be shared or sold to any parties beyond those parties.
Name of Person Completing Inquiry Form (social name, not formal)*

First NameLast Name
Were you referred by someone outside of FullyFundable or Dan Kalis?

NoYes
Referral Source:
General Company Information
Primary Business Legal Name of Company Requesting Funding*
Official Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Business Phone*

Area CodePhone Number
Company URL / Website Address (of primary business homepage)*
Desired Loan/Funding Amount*
(Range: What's the least and most amount you can put to productive use in the near future?)
Desired Use(s) of Funding (check all that apply)*

Working CapitalMarketing/AdvertisingHiring / StaffingInventoryBusiness Travel (Transport, Lodging) / Events / NetworkingProfessional Training / Continuing EducationEquipmentDebt Consolidation/RestructuringResearch & Development (R&D)SuppliesTechnologyConstructionExpansion (add additional location(s) of same business)Business AcquisitionOther
What (additional) types of marketing/advertising are you planning to do?
What positions are you looking to hire?
List Debts to be Consolidated (Creditor/Type/Balance/Payment)
What is your urgency level for this funding inquiry?*

We need an infusion of outside capital/credit ASAP (within 1 week)We need/want an infusion of outside capital/credit in the next 30 daysWe're looking to line up some additional capital/credit for the next 30-90 daysWe're just exploring my options but don't really need any outside capital within the next 90 days
What type(s) of funding are you open to exploring? (check all that apply)*

SBA loan (10-year payback term; no prepayment penalty; best rates; most documentationBusiness Line of CreditBusiness Credit CardsShort Term Revenue Advance/Bridge Loan (6-12 month term; early payoff incentives; highest rates; least documentation)Equity Crowdfunding/Online Private Capital RaisingAlternative IRA (invest retirement funds in your own company)GrantsOrganic/Reverse Funding (Revenue/Profit Optimization)
Taxable Entity Type:*

Sole ProprietorLLCCorporationSPV / SPEOther
State of Entity Registration*
(or state of residence if Sole Prop.)
Company Basis (check all that apply)*

Home-based/Remote/VirtualLease Commercial SpaceOwn Commercial SpaceCo-Working SpaceOther
Business Start Date (Month/Year) (since incorporation)*
Industry (NAICS code, if you know it)*
Briefly describe what your business does, who it serves, and anything unique about your products/services, business model, expertise, etc.*
Company Value, Sellability, and Management

This section is to help determine your company's scalability and level of attractiveness in the eyes of various lenders, investors, and/or acquirers
Have you ever had a formal/detailed business valuation done on your company?*

YesNo
When was it done, by whom, and what was the number?
Would you like a complementary estimate of current business value and sellability assessment*

YesNo
Exit-mindedness:*

Thinking of selling my company ASAPThinking of selling my company within the next 12 monthsThinking of selling my company within the next 1-3 yearsNot currently exit-minded at all
Company dependence on you, as the owner:*

The company cannot currently run without my direct involvementI have a competent CEO/COO/GM who can/does run the companyI have a full C-Suite of non-owner managers running the companyOther
(optional) Feel free to share any additional details about your company's value, sellability, and/or dependence on your direct involvement
FINANCIAL INFORMATION

(for all financial #s include dollar sign & commas for clear legibility)
Business Bank Name*
Merchant/Payment Processor(s)*
(e.g. Stripe, Square, PayPal, LawPay, Fiserv, etc.)
Average Monthly Sales (in past 6 months)*
(please include dollar sign and commas for clear legibility)
2025 Gross/Top-line Revenue/Sales*
2025 Net Income (Profit/Loss)*
2024 Gross Revenue as reported on your business tax return *
(or "On Extension")
2024 Net Income (Profit/Loss) as reported on your business tax return*
(or "On Extension")
2023 Gross Revenue as reported on your business tax return *
(or "On Extension")
2023 Net Income (Profit/Loss) as reported on your business tax return*
(or "On Extension")
2022 Gross Revenue as reported on your business tax return*
2022 Net Income (Profit/Loss) as reported on your business tax return*
Do you regularly carry Accounts Receivable (A/R)?*

YesNo
TOTAL amount of current A/R (if you don't know by aging)
Amount of current A/R (less than 30 days aging)
Amount of current A/R (30-60 days)
Amount of current A/R (60-90 days)
Amount of current A/R (91+ days)
Does your business own product inventory?*

YesNo
What types of products and how much TOTAL inventory value currently?
Do you own back taxes to the IRS?

NoYesUnsure
For which years do you owe back taxes to the IRS?

2023202220212020Older
Are you on a payment plan with the IRS and in good standing?

YesNoIn process of setting one up now
How much are your total business expenses per month (average)?*
e.g. $10,000
How many months of business expenses do you have in cash reserves?*

01-34-67-12More than 12
How much available BUSINESS credit do you have (business credit cards and business lines of credit)*
How much available PERSONAL credit do you have (personal credit cards)*
Business Financial History
Types of Business Loans You've Had Previously (check all that apply)*

SBA 7aBusiness Line of CreditMerchant Cash Advance (MCA)Business Credit Card(s)Bank Term LoanA/R FactoringEIDL (SBA)PPP (SBA)MezzanineOther
Have you ever defaulted on any of these business loans?*

YesNo
Please list type of loans on which you've defaulted*
Total CURRENT Commercial Debt and Monthly Payment (estimate)*
List any ASSETS owned by your business (or personally) that could be pledged as collateral (type/class, estimated value, and available equity)*
(or N/A if none)
Company Ownership / Guarantors
How many partners of the company have at least 20% ownership*

12345
Primary Applicant (20%+ Owner)
Name of Applicant #1*

First NameLast Name
% Ownership*
Title*
Are you a United States Citizen or Permanent Resident (Green Card Holder)?*

YESNOIn Process
Mobile Phone Number*

Area CodePhone Number
Email Address of Applicant*
Estimated Personal Credit Score (type actual score under "Other" if you know it)*

800+ (elite)749-799 (exceptional)700-749 (prime)650-699 (good)600-649 (fair)< 600 (poor)Other
Primary Residence*

OwnRent
Property Value (estimate)
Amount Owed on Primary Residence (estimate)
#2 Applicant (20%+ Owner)
Name of Applicant #2 (only if 20%+ owner)*

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Estimated Personal Credit Score (Applicant #2)*

800+ (exceptional)700-799 (prime)650-699 (good)600-649 (fair)< 600 (poor)Unsure
% Ownership of Applicant #2*
#3 Applicant (20%+ Owner)
Name of Applicant #3 (only if 20%+ owner)*

First NameLast Name
Estimated Personal Credit Score (Applicant #3)*

800+ (exceptional)700-799 (prime)650-699 (good)600-649 (fair)< 600 (poor)
% Ownership of Applicant #3*
#4 Applicant (20%+ Owner)
Name of Applicant #4 (only if 20%+ owner)*

First NameLast Name
Estimated Personal Credit Score (Applicant #4)*

800+ (exceptional)700-799 (prime)650-699 (good)600-649 (fair)< 600 (poor)
% Ownership of Applicant #4*
#5 Applicant (20%+ Owner)
Name of Applicant #5 (only if 20%+ owner)*

First NameLast Name
Estimated Personal Credit Score (Applicant #5)*

800+ (exceptional)700-799 (prime)650-699 (good)600-649 (fair)< 600 (poor)
% Ownership of Applicant #5*
Please add any other information about your business and situation that you believe is important for us to know when determining what type(s) of funding may be most ideal for you right now, and in the future (help us come up with a "funding plan" for you, not just a one-off business loan.
Should be Empty:

BUSINESS FUNDING INQUIRY/ASSESSMENT

General Company Information

Company Value, Sellability, and Management

FINANCIAL INFORMATION

Business Financial History

Company Ownership / Guarantors

Primary Applicant (20%+ Owner)

#2 Applicant (20%+ Owner)

#3 Applicant (20%+ Owner)

#4 Applicant (20%+ Owner)

#5 Applicant (20%+ Owner)