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First Name
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Last Name
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Email:
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Address:
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Address 2:
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City:
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State:
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Zip: mailing
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Phone:
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Requested Loan Amount
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What do you need the loan for?
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Buy Real Estate
Refinance Real Estate
Buy / Refinance Machinery or Equipment
Business Acquisition
Business Startup
Working Capital
Please rate your credit
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Great (score 720+)
Good (680 - 719)
Fair (650 - 679)
Poor (less than 650)
How many years has the business been in operation?
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Haven't opened yet
<2 years
2 - 4 years
5+ years
How many years of industry experience do you have?
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< 2 years
2 - 4 years
5 + years
For existing businesses: Do you think your business historically generates enough net income to easily cover this future loan and current existing debt?
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Yes
No
N/A (Business Startup)
Required
What County is your business located in?
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Your answer
What zip code does your business primary operate in?
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Your answer
If your business in not located in Florida what State is it located in?
Your answer
If you talked to any Banks already let's take them out of the mix. Please list any bank(s ) you talked to:
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What category best describes your business?
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Agriculture
Automobile Dealer
Automotive Repair and Mainentance
Bar/Tavern
Construction Related Trade / Industry
Daycare/ Children’s Nursery
Finance / Insurance related
Fitness
Forestry, Fishing, and Hunting
Gas / Service station
Grocery / Supermarket / Convenience Store
Hotels and Other Lodging Places
Landscape & Yard Services
Legal Services
Liquor Store
Manufacturing
Medical - Chiropractor
Medical – Other
Medical – Physician / Dental / Veterinarian
Non-Profit Organization
Real Estate Sales or Rental
Religious Organization
Restaurants / Food Services
Retail Other
Storage or Warehouse
Transportation
Trucking - Freight
Wholesale Trade
Other Services – Business to Business
Other Services – Business to Consumer
Can loan be 100% secured by Real Estate?
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Yes
No
Required
Is 51% or more of the business owned by U.S citizen(s) or a U.S. permanent resident aliens?
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Yes
No
Required
For new businesses: Do you have additional sources of income that can help pay this loan?
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Yes
No
N/A well established company
Required
Please enter the sales price if most of the proceeds will be used to buy an asset
Your answer
Complete the following two questions if you are buying or refinancing real estate
Real Estate: Will you occupy 51% or more of the property?
Yes
No
Real Estate: What type of property do you want to buy or refinance?
Choose
Agriculture
Apartment(s)
Auto/Vehicle Related
Golf Course
Hotel/Motel - Bed & Breakfast
Hotel/Motel - Flag
Hotel/Motel - Independent
Land - Multifamily Use
Land - Commercial Use
Marina
Mobile Home / RV
Multifamily Residential
Nursery, Greenhouse, Floriculture
Office - Business Park / Business Center
Office - Condo
Office - Medical
Office - Warehouse
Office - Building
Religious Facility
Residential Investment
Retail - Anchor
Retail - Car Wash
Retail - Day Care Center
Retail - Dry Cleaning / Laundry Services
Retail - Free Standing Building
Retail - Funeral Home
Retail - Gas/Service Station
Retail - Restaurant
Retail - Specialty Center
Retail - Strip Center
Retail - Other
Senior Housing - Assisted Living Facilities
Senior Housing - Congregated Senior Housing
Special Purpose (Other)
Storage Facility
Theater/Performing Arts/Entertainment Center
Warehouse
Other
Complete the following 3 questions if you are buying or refinancing machinery or equipment with the loan proceeds
Machinery or Equipment: Interested in:
Choose
Operating Lease (You don't want ownership)
Capital Lease (You eventually want ownership)
Sale Leaseback (You have equipment that you want to borrower on)
Machinery or Equipment: Type of Equipment:
Choose
Agricultural
Construction
Exercise/Gym
Golf
Landscaping
Medical/Health Care
Office
Restaurant
Trucking/Transportation
Other
Machinery or Equipment: Age of Equipment
Choose
New Equipment
Less than 2 yrs old
2 -4 yrs old
4-6 yrs old
6+ years old
Complete the following 2 questions if this is a business startup
Business Startup: Can you come up with at least 25% of the needed funds to start the business?
Yes
No
Clear selection
Business Startup: If no, for the above question, can you come up with 15% of the needed funds for the business?
Yes
No
N/A
Clear selection
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