First
Name:
Last Name:
Street
Address:
City:
State:
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Age:
Home Phone:
Cell Phone:
Business Phone:
Email Address:
Best time to call:
Which Number:
Home Phone Business Phone Cell Phone
Are you looking
for a:
Loan
Lease
Have you Chosen a
Franchise?
Yes No
$ Amount of Loan
or Lease Needed::
If yes, name of
Franchise:
How is your
personal Credit?
Fair Good Excellent
Do you know what
your credit score is?
Have
you had a bankruptcy within the last 10 years? Yes No
How
much credit card debt, if any, do you have? $
Current/latest
occupation:
Current/latest
job title:
Current/latest
salary: $
Would
you still be retaining your current salary? Yes No
Do
you own a home or other property? Yes No
How
much equity is in your home(s)?
Do
you have a second household income? Yes No
Total approximate
assets:
$
Total approximate
liabilities:
$
Total approximate
liabilities:
$
What is your
approximate net worth?
$
Available
cash to invest: $
Are
all your taxes current? (personal or business): Yes No
Have
you applied for an SBA or Business Loan before? Yes No
Were
you approved?
Yes
No
Are you a US
citizen?
Yes No
If no, do you
have a green card?
Yes No
Have
you ever been charged with, arrested or convicted of any criminal
offense other than a minor vehicle violation? Yes No
Have
you ever owned a business or franchise before? Yes No
If
yes, please explain:
What
is your timetable:
0-3
months 4-6
months 7-12
months Over
1 year
Additional
Comments:
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