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Client Information
Full Name
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Company Name
*
Business Address
Street Address
City
State/Province
Postal/Zip Code
Email
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Phone
*
Funding Request
Are You Purchasing a Business?
Yes
No
If Purchasing a Business, Will It Involve Any Real Estate
Yes
No
If There is Real Estate Involved, List Property Address
Address Line 1
Address Line 2
City
State
Zip Code
Amount of Financing Requested?
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Average Monthly Sales
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Actual Gross Sales Last Year
$
Purpose of Loan
Nature of Business
Credit Score
How Soon is the Funding Needed?
How Many Years of Business Tax Returns Do You Have?
Do You Own Primary Residence
Yes
No
Do You Have Any Other Short-Term or Tax Lien?
Yes
No
If YES, How Many Loans, and Total Balance?
How Many Loans?
Total Balance?
Liquid Assets
Types of Assets
Cash
Real Estate
Retirement
Insurance
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Balance or Value? ($ Amount)
How Many Full-Time Employees Do You Have?
Notes
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