Client Intake Form

Personal Information:

Full Name

Date of Birth

Social Security Number (SSN)

Phone

Address

Business Information:

Business Name

Business Type

Business Address

Employer Identification Number (EIN)

Business Website

Business Start Date

How long have you been in business?

Do you currently have business credit established?

What is your business's monthly or annual revenue?

What is your estimated annual profit?

Do you currently have any outstanding business loans?

What is the approximate amount of funding you're seeking?

Have you applied for business funding in the past?

Additional Information:

Preferred method of communication

Additional Comments

By submitting this form, you give permission for us to perform a soft pull of both your personal credit and business credit to determine your anticipated funding qualifications. A soft pull will not affect your credit score.

By submitting this form, you give us permission to review your business credit history for the purpose of evaluating your business’s funding eligibility.

We value your privacy. All personal and business information will be kept confidential and secure.

Thanks for submitting!