Building Billions Funding Intake Form 
Please fill out information below completely and accurately to prevent delays. 
Please keep in mind our funding fee is 10% fee of the total amount funded. Ex: Secure $100k our fee is $10k 
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What type of funding are you looking for? *
Credit Score  *
Full Name (First, MI, Last )  *
Phone Number *
Address
Personal Email Address
Date of Birth *
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Social Security Number 
Mother's Maiden Name *
Driver License Number  *
Driver License Issued State *
Driver License Issue Date *
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YYYY
Driver License Expiration Date *
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Name of Employer (If self-employed please select N/A and continue) *
Employer Address  *
Employer Phone Number *
Current Job Title *
Years at Position  *
Total Household Income *
List of current Credit Cards Personal +Business
Credit Karma Username *
Credit Karma Password *
Experian Username  *
Experian Password *
Business Formation Type
Clear selection
Business Name
Business Address
Business Phone Number
Business Email
Business Established Date (mm/dd/yyyy)
Business Website
Dunns Number
Ein Number
Business Bank Accounts Currently Open
NAV.com User Name (Business Scores)
NAV.com Password (Business Scores)
Business Credit Cards Currently Open
Business Credit Lines Currently Open
Business Total Annual Revenue
Select Financial Documents you can prove if banks ask
How much funding are you seeking?
Clear selection
Referred By: 
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