Business Loan Pre Qualification Form

Business Name / DBA *

Business Industry *

How Much Capital Do You Need? *

0-15,000
15,000-30,000
30,000-45,000
45,000-60,000
60,000-75,000
75,000-100,000
100,000+
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Custom Amount

How Soon Do You Need The Funds? *

Immediately
Within A Week
Within 2 Weeks
Within A Month
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What Most Important? *

Speed
Cost
Term
Approval Amount
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What Are You Seeking Funds For? *

Working Capital
Expansion
Equipment
Marketing
Payroll
Finance Accounts Receivable
Buy Out A Partner
Purchase A Business
Purchase A Franchise
Start A Business
Other
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How Long Have You Been In Business? *

Owner Details

First Name *

Last Name *

Phone *

Email *

Personal Credit Score *

By checking this box I acknowledge that Queen City Credit Clinic and all involved parties will NOT be selling my information to any third parties and I consent to receive phone calls, emails and/or text messages ONLY regarding the status of my application along with any future educational marketing material.

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