JiCor Intake Form

JiCor Consulting Corp

Client Intake Form
Date*

MonthDayYear
Client Onbaroding Information
Please provide information for the main contact person
Client Name*

First NameLast Name
Client Title
Client Phone Number

Area CodePhone Number
Client Email
example@example.com
Do you have an appraisal or documentation of the estimated value?

YesNo
What is the value of the appraisal?
Financials
Do you have 3 years of your past financials?

YesNo
Business Information
Identify the business type

LLCLLPS CorporationC Corporation
Are you the Sole Owner of your business?

YesNo
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number

Area CodePhone Number
Brief Business History
Business Fax

Area CodePhone Number
Business Website
Project/Request Overview
What type of funding are you requesting

PurchaseRefinancingProject Development
Provide a brief summary of the project including the requested loan amount and deadlines.
Assessment Documentation

Please complete the following section with as much detailed information as possible. This will help us identify the areas assistance is needed. If there are items you do not have, please indicate that. We may be able to provide services in those areas. All questions are specific to the project you are seeking funding for.
What is the current value of this project?
What is the after-construction value?
How much funding is needed for completion?
How much funding is currently invested?
How much cash reserves do you have available?
Do you have a "Sources & Uses of Funds" document?

YesNo
Please rate your credit

PoorGoodExcellent
Company/Project Documentation

Do you have the following? :
A copy of your Articles of Incorportation

YesNo
By-laws

YesNo
Executive Summary

YesNo
Resume for Project Members

YesNo
Financial documentation including P & L Statement

YesNo
Leases or Letters of Interests on the property

YesNo
Feasibility Study

YesNo
Pro-Forma

YesNo
Drawing, blue print, or architect renditions

YesNo
Should be Empty:

JiCor Consulting Corp

Company/Project Documentation