Business Funding Intake
General Information
Borrower
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Credit Score
Co-Borrower?
Yes
No
Co-Borrower
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Credit Score
Business Information
Entity Name
*
Formation State
*
Entity Structure Type
*
Business Industry
*
Years in Business
*
Avg Monthly Revenue
*
Have 3 Months of Business Bank Statements?
*
Please Select
Yes
No
Additional Notes
Submit
Should be Empty: