Customer Finance Intake Form
By completing this form you agree that we may contact you at the phone number(s) and email address provided to discuss customer financing options, answer questions, and complete the process. If you provide your mobile number, this contact may include text messaging. Providing a mobile number is not a condition of this funding.
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Company Name *
Owner or Contact Name? *
Contact's Email Address? *
Contact's Mobile Number? *
Nature of Business? *
Sales Process? *
Do You Currently Offer Customer Financing *
If so, any Pain Points with your current provider?
If so, your approximate monthly financing?
Average Sale or Ticket Amount? *
Gross Annual Sales? *
Business Established Date? (approximate) *
MM
/
DD
/
YYYY
State(s) business located in? *
Name of Bridgepoint Agent Who Referred You? *
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