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What type of business financing are you interested in obtaining at this time?

Business loan
Cash advance against credit card income
Loan for equipment purchase
Equipment lease
Commercial mortgage loan

Approximately how much are you requesting for this business loan or cash advance?

$15,000 - 24,999
$25,000 - 49,999
$50,000 - 99,999
$100,000 - 249,999

$250,000 - 499,999
$500,000 - 999,999
$1,000,000 - 1,999,999
$2,000,000+

Are you looking for a loan for a business that you are about to start, a business that you already own, or a business you want to acquire?

A business that I am about to start
A business that I own currently
A business I would like to acquire

For what purpose(s) are you looking for business financing at this time?

Business expansion
Business purchase or acquisition
Franchise purchase
Real estate purchase or commercial mortgage
Equipment purchase
Debt consolidation
Property or facilities remodeling or enhancement
Other :

How long has your business been in operation?

0-6 months (Start-up)
6 months-2 years
2-4 Years

4-5 Years
5+ Years

Do you have any credit issues which may impact the type or amount of financing available to you?

No - Clean Credit
Yes - There are or may be credit issues

If Yes, please describe in the space below and note your FICO (3 digit) credit score if known:

What were your business' total revenues over the past 12 months?

$0 revenue - start-up
Less than 99,999
$100,000 - 299,999
$300,000 - 499,999

$500,000 - 999,999
$1,000,000 - 4,999,999
$5,000,000+

What is the approximate total value of the assets you have to secure this commercial loan?

$10,000 - 49,999
$50,000 - 99,999
$100,000 - 299,999
$300,000 - 499,999

$500,000 - 999,999
$1,000,000 - 4,999,999
$5,000,000+

Do you own a home or other personal real estate that could be used as collateral?

Yes
No
Not sure

Does your business currently accept Visa or MasterCard as a form of payment?

No - we do not accept Visa or Mastercard
Yes - we accept Visa and/or MasterCard

If yes, please note your approximate monthly processing volume:

$0 - $5,000
$5,000 - $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000+

What is the five digit ZIP code for your office location?[?]

What is your e-mail address? [?]

Please briefly describe the business and any further details regarding your financing needs.

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