Form

Pre-Qualification/ Assessment Form

This form will be used to perform a series of Soft-Pull Assessments toward multiple Business and or Personal Credit Lines. These may include Term Loans, Credit Cards & Lines of Credit.

Let’s begin... This will not affect your credit score.

Email*

Funding Request: Amount Requested

Detailed Use of Fund*

Please enter as much information possible, so that we can properly assess your Loan Request.

Experian Credit Score

Equifax Credit Score

TransUnion Credit Score

First name*

Middle Name or Initial

Last name*

Phone number

Mobile Phone Number*

Street Address*

City*

State/Region*

Postal Code*

Date of Birth*

MM/DD/YYYY

Month/Day/Year

Marital Status*

Housing Status Drop Down*

Monthly Housing Payment*

How long have you lived at this address?

College/Military information

By entering your College and or Military information, it can help to reduce Interest Rates on Loans & Lines of Credit.

College/University Attended

Degree

Field of study

Graduation Date

Employer/Business & Income Information

Employer*

Employer Phone Number

Occupation/Position*

Start Date with Employer

Month-Day-Year

Stated Monthly Personal Income

Stated Annual Household Income

Combined Checking & Savings Balance*

Stocks, Bonds & Mutual Funds

Retirement Account Balance

If you are seeking funding for your Existing Business, please enter Data below:

Company name

DBA Name

Street address

City

State/Region

Postal code

Business Start Date

Month/Day/Year

Entity State

EIN/Tax ID#

Corporate Structure

Gross Annual Revenue (2020)

Net Profit (2020)

Gross Annual Revenue (2021)

Net Profit (2021)

Gross Annual Revenue (2022)

Net Profit (2022)

YTD Gross Revenue

Business Location

Monthly Lease or Commercial Loan Payment

Number of Employees (Range)

Website URL

E-Signature*

PLEASE NOTE: Our Commitment to Privacy All information stored in our database is secure and is strictly confidential. Your personal and credit information will only be used to fulfill your request and in accordance with our Privacy Policy. Acknowledgement and Consent By clicking the "I Agree / Submit" button and providing an electronic signature below, you certify that all of the statements in this application are true and made for the purpose of obtaining credit, and you are confirming you have read and understand the Privacy Policy and the Application Disclosure, and you are authorizing this company under all applicable federal and state laws, including the Fair Credit Reporting Act, to obtain information from your personal credit profile. This form that you have filled out on our website is not a loan application, but a request to obtain prequalification. Also, you are confirming you understand that any pre-approval is subject to review and acceptance of credit information.