Loan Assessment Form

- Step 1 of 9

Loan Applicants Name: *

First

Last

Best Phone Number to Call: *

Email: *

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Perfect time for us to call you? *

• Morning
• Afternoon
• Evening

Call Time and Date? *

Date

Time

Apply for? *Real Estate Fix & Flip LoansLine Of Credit LoansWorking Capital LoansPurchase Order Financing LoansCash Advance LoansAccounts Receivables Financing LoansEquipment Financing LoansInvoice Factoring LoansConstruction & Contractors LoansAgricultural LoansAuto Repair Business LoansBars & Brewery LoansCommercial Fishing LoansDental & Medical Practice LoansGas Station LoansGrocery & Convenience Store LoansLaw Firm LoansRestaurant LoansSaloon & Barber Shop Loans

Amount you need to borrow? *

Have you recently applied for any funding from other lenders? *

• Yes
• No

Have you recently applied for any funding from other lenders? If "YES", when was the last time that you applied and from which lender?

SPECIFY MONTH / DATE / YEAR:

SPECIFY WHICH LENDER

WAS IT APPROVED? *

• Yes
• No

Have had any defaults on your past fundings?

SOURCE of Application: *

• Internet
• Email
• In Person
• Walk-In
• Phone

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Are you a citizen, resident or valid visa holder currently residing in the United States of America? *

• Yes
• No

Are you a Business Owner? *

• Yes
• No

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Is your business currently operating? *

• Yes
• No

What Industry is your business in?

How long have you been in business?Purchase Business0-3 months3-6 months6-12 months1+years

Are you currently accepting credit cards? *

• Yes
• No

If you accept credit cards, how much do you process monthly? *

• VISA - less than $5k
• VISA - $5k+

SPECIFY AVERAGE AMOUNT

MC *

• M/C - less than $5k
• M/C - $5k+

SPECIFY AVERAGE AMOUNT

AMEX *

• AMEX - less than $5k
• AMEX - $5K+

SPECIFY AVERAGE AMOUNT

SBIT *

• DEBIT - less than $5k
• DEBIT - $5K+

SPECIFY AVERAGE AMOUNT

If you accept credit cards, how much do you process monthly? *

• VISA - less than $5k
• VISA - $5k+
• M/C - less than $5k
• M/C - $5k+
• AMEX - less than $5k
• AMEX - $5K+
• DEBIT - less than $5k
• DEBIT - $5K+
• SPECIFY AVERAGE AMOUNT

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Does your company have a Business Checking Account? *

• Yes
• No

In order to avoid any funding delays, can you provide your last 3 months business bank statements? *

• Yes
• No

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Do you have your current Business Bank Statements for the last 3 months? *

• Yes
• No

Do you own any Real Estate? *

• Yes
• No

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Do you have a close relation or business partner willing to let their Real Estate property stand as collateral for your current loan application? *

• Yes
• No

What Type of Real Estate do you have? *ResidentialCommercialIndustrialVacant Land

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Property Location? *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

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What is your average monthly deposit into your Business Checking account? *Start Upless than $5k per month$5k-$8k per month$8k-$10k per month$10k-$20k per month$20k-$50k per month$50k-$100k per month$100k+ per month

What is your average gross monthly sales for the past 3 months? *Start Upless than $5k per month$5k-$8 per month$8k-$10K per month$10k-$20k per month$20k-$50k per month$50k-100k per month$100k+ per month

What is your credit score? *Below 600600-649650-679680-719720+

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