Questionnaire Form

1.What type of business do you own?

Select Option:

Limited Liability Company (LLC)

Sole Proprietorship

Partnership

C Corporation

S Corporation

N/A

2.How much do you need?

Numerical Amount: *

3.What are you seeking funding for?

Please Choose:

Other

Buy A Business / Franchise
Expansion
Equipment Purchase
Inventory
Marketing / Sales
Payroll
Remodel Building
Refinance Debt
Start A Business
Cash Flow / Working Capital
Other
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4.What’s your annual revenue?

Annual Revenue:

5.What’s your estimated personal credit score?

Select Option:

Excellent (720+)

Good (680-719)

Far (640-679)

Poor (639 or less)

6.What industry is your business in?

Please Select:

Accommodation & Food Services
Administrative & Support
Agriculture, Forestry, Fishing & Hunting
Arts, Entertainment, & Recreation
Construction
Educational Services
Finance & Insurance
Health Care & Social Assistance
Information
Management of Companies & Enterprises
Manufacturing
Mining
Other Services
Professional, Scientific & Technical Services
Public Administration
Real Estate Rental & Leasing
Retail Trade
Transportation & Warehousing
Utilities
Waste Management & Remediation Services
Wholesale
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7.What is your business name?

Business Name *

8.What is your name?

First Name

Last Name

9.What’s your phone number to reach you?

Phone *

10.What’s your email address?

Email *

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