Business Loan Intake Form

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Business Loan Intake Form

Please fill out the form below. A loan broker will call you shortly after you submit it to review your options.

Name of Business *

Business Structure (Choose One) *

Sole Proprietorship

LLC

C-Corp

S-Corp

Other:

Description of Business Industry *

Registered Address of Business *

(This is the address where your business is legally registered with the state.)

Mailing Address if Different from Registered Address

Business Phone Number *

Start date of business *

YYYY

Name of Owner(s) of Company and Percentage of Company Owned *

Estimated personal credit score of owner(s). *

Name of contact person for this loan *

Cell phone number of contact person for this loan *

Email address for contact person for this loan *

Loan Amount Requested *

Purpose of loan *

Average gross monthly revenue *

Does the business have other loans now? *

Yes

Are there any bankruptcies, liens, collections or open lawsuits on the business or any of the owners? *

Yes

Has the business ever defaulted on a loan or had debt forgiven? *

Yes

Are there any delinquent taxes on the part of the business or the ownership? *

Yes

Who referred you? *

Submit

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