Funding Pre-Qualifier

Funding Pre-Qualifier

Please fill out the funding pre-qualifier form below and we will contact you to setup an initial consultation call:

* Required Fields

* Where did you find us? Other
*Your Name:		Work Phone:
Business Name:		Home Phone:
* Address:		Cell Phone:
* City:		* Best Contact Phone:
* State/Country * Zip		* Best Time to Call:
* Email Address:		Alternative Email:


Do you have a Master Finanacial Associate you would like to talk with if they are available?
* Amount Of Capital Needed: * * Timeframe for Required Capital Type of Funding Preferred:
Are you interested in an Interim Personal Loan of up to $50,000 until your project gets funded:
Are you interested in a Business Bridge Loan of up to $250,000 until your project gets funded:
* Enter a Brief Description of What the Capital Will Be Used For:

Business Information:
Legal Description of Business	Current Business Status (Hold Down Ctrl Key to select more than one)	Industry Description (Hold Down Ctrl Key to select more than one)

Current Business Stage * Service Description of Business:
Years in Business:	* Money Invested to Date:
*Can you personally provide any additional funds for your project:
* How much?
For Real Estate Loans Only:
Property Consists of: Value: Appraised? Amount Owed Against

*Personal Credit of Participating Principals:

Credit History:

Credit Score (if known):

* Principal 1:

Principal 2:

Principal 3:


Financial Status: Your answers to the following questions regarding your credit and finances have no bearing on whether or not we take you on as a client, but rather serves as an aid in analyzing your total situation and in developing the right funding strategy to fit your specific capital requirements.
Assets/Collateral Available:
Please check all that apply and fill in box underneath estimating Cash Value of Properties/Auto and Credit Lines available in each area checked:
Home	Commercial Property		Auto		Credit Card / Credit Line
* Status of Credit Card Limit? If Credit Card Limit is maxed or you have a medium to high interest rate would you like to consider a consolidation loan?
Documents Available: Business Plan Executive Summary Private Placement Memorandum Financials Other
* Business Plan Prepared By: * State of Business Plan: (Hold Down Ctrl Key to select more than one)		* If you Have Financials, Which Ones: (Hold Down Ctrl Key to select more than one)	Financials Prepared By:
Comments:
Thank you for taking the time to complete this questionnaire!