Business Credit Intake form

Company Info

Your Full Name *

Email *

Phone *

Name of Business *

Is Your Business Incorporated with your State Department? *

What state, county or borough did you incorporate your business in?

Business Type *

How long have you been in business or incorporated? *

Do You Have an Employer Identification Number (EIN)? *

Do you have a DUNS Number or type, not sure? *

Do you have a business logo, brand/color? *

Does you business have a social media presence, i.e FB, IG, LinkedIn, Twitter, etc? *

Do you have a business website? If so, please list.

Where is most of your business work done? *

Separate, physical business structure

Home/Residence

Virtual Office space

Are you the sole owner of this business? If not list partner, member, etc.

Are you currently or have you previously built business credit with this business? *

If yes to previous question, do you have any delinquencies on your business credit report? *

How did you hear about us?

Company Financials

How many paying clients do you currently have or had in the past year, if any?

How much revenue are you currently generating from your business monthly, if any?

What is your target monthly revenue?

What is your company's monthly operations budget? (money to grow your business)

How is your personal credit score?

400-500's

600's

700's

800's

Any additional information you would like to provide to help me better understand why you're currently seeking business credit and funding.