Full Application
Required Docs
Useful Documents
Construction Budget
Useful Documents
Construction Budget
What kind of program are you looking for?
- Select -
Blanket/Portfolio Loan
Bridge Loan
Commercial Bridge
Conventional Financing
New Construction
Fix and Flip
Land
Multifamily
DSCR Rental Loan
SBA-504
SBA Loan product
SBA 7a
SBA 504
Micro Loan
SBA Express
CAP Line
Community Advantage
SBA Veterans Advantage
International Trade
Export Working Capital
Export Express
Payroll Protection Program
EIDL
Additional Desired Loan programs
Blanket/Portfolio Loan
Bridge Loan
Commercial Bridge
Conventional Financing
New Construction
Fix and Flip
Land
Multifamily
DSCR Rental Loan
SBA-504
Where are you in the process?
Have Property Under Contract
Lead Source
- Select -
Banner Ad
Direct Mail
Google Ad
Google Search
Referral from Friend
Trade Publication
Trade Show
Other
Broker/Referring Party
Fabiola Lima
Borrower Info
First Name
Frank
Middle Name
Last Name
Flipper
Borrower Email
sdkjlfak@aim.com
Please Wait...
Secondary Email
2@lendingwise.com
Home Phone
(305) 606-2360
Cell Phone
(305)-606 - 2360
Fax
Cell Carrier
Verizon
Preferred Communication
Phone
Is there a Co-borrower?
Yes
Alt. Phone #
Work Phone #
Address
4520 sw 62nd ct
Unit #
City
miami
State
Zip Code
33155
County
Country
Length of time at the present property
Length Of Time At The Present Property Months
0
Rent or Own
Rent Per Month Current Address
Has the borrower resided at the present address for less than two years?
Mailing Address
Mailing Address same as Current Address?
Mailing Address
4520 sw 62nd ct
Mailing Address Unit#
Mailing City
miami
Mailing State
Florida
Mailing Zip Code
33155
Mailing Address Country
Alternate Names
Alternate Section
1
First Name
First Name
First Name
Personal Info
Date Of Birth
04/06/1981
Place Of Birth
Social Security Number
654 - 64 - 5555
Driver License State
Driver License Number
Marital Status?
Date of Marriage
Date of Divorce (If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Citizenship
Did you ever serve, OR are currently serving IN the United States Armed Forces?
Servicing member Info
Projected Expiration Date of Service/Tour
Ages Of Dependents
Number Of Dependents
0
Mid Fico Score
650
Equifax Score
Transunion Score
Experian Score
Credit Score Range
720 +
Co-Applicant Information
First Name
Jane
Last Name
Flipper
Email Address
janeflip@test.com
Please Wait...
Home Phone
Cell Phone
Fax
Mobile Service Provider
Same as borrowers address?
No
Address
City
State
Zip Code
Rent or Own
Is the Co-Borrower Guaranteeing the loan?
Length of time at address
Has the borrower resided at the present address for less than two years?
NA
Previous Address
Previous City
Previous State
Previous Zip Code
0
Rent or Own
Mailing Address
Same as borrowers mailing address?
Mailing Address
Mailing City
Mailing State
- Select -
Mailing Zip
Personal Info
Date Of Birth
Place Of Birth
Social Security Number
Driver License State
Driver License Number
Driver License Issuance Date
Driver License Expiration Date
Marital Status?
Married to Borrower?
Citizenship
Equifax Score
Mid Fico Score
Transunion Score
Experian Score
Credit Score Range
Borrower Type/Entity Info
Borrower Type
Entity
Trust Type
Retirement Entity
General Business Info
Entity Name
House Flips, LLC
Trade Name/DBA
Entity Type
LLC
Date Of Formation
02/05/2008
Time in Business
State Of Formation
GA
States Registered In
Federal Tax ID/EIN
32 - 5645651
Business License Number
Issuance Date
Expiration Date
State Issued
Other States Operating In
DBA Name(s)
Prior Business Name(s)
Organizational Ref #
Business Phone
Website Address
Business Address
Start Date at Location
Address
1200 S dixie hwy
City
miami
State
FL
Zip Code
33155
Is the billing address the same as above?
No
Billing Address
Billing City
Billing State
Billing Zip Code
Location
Property Ownership
Value of Property?
Total Debt on Property?
Name of Lender(s)?
Landlord/Mortgage Contact Name
Landlord/Mortgage Phone
Rent/Mortgage Payment
0.00
Business Details
Business Type
# of employees currently
0
# of employees after loan
Business Category
Type of product or service sold
Naics Code
Does your business sell a
Is your Business
Is your business home based?
Do you take credit card payments?
Terminal/ POS Make/Model
How many card processor banks do you have active?
Merchant Processing Bank Name(s)
Do you charge sales tax?
How are employees paid?
Do you have more than one business location?
How many locations?
Other Location Details & Addresses
Is the business a franchise?
Name of Franchise
Point of Contact
Point of Contact Phone
Point of Contact E-mail
Website for Franchise
is your business seasonal?
if Yes, what are the peak months?
Business Description
Do you have Business Reference(s)?
1
)
Phone Name
Company
Fax
Email
Business Financials
Average Monthly Credit Card Sales
0.00
Average Monthly Deposits
0.00
Annual Revenue
0.00
Annual Gross Profit
0.00
YTD-Net Business Income
0.00
Date of Operating Agreement
Gross Annual Revenues $
0.00
Gross Income Last Year
0
Net Income Last Year
Gross Income 2 years ago
Net Income 2 years Ago
Average Bank Balance
Has business ever filed for bankruptcy?
Status of Business Bankruptcy
Recent NSFs
Does your business owe taxes for years prior to the current year?
Estimated amount owed
Members/Officers
(List all members with 20% ownership or more.)
Name
Frank Flipper
Title
President
% of Ownership
50
Annual Salary/Compensation
0.000
Address
123 main
Phone
Cell
(305) 606-2360
SSN
555 - 55 - 5555
DOB
01/16/1923
Credit Score
Email
frank@lendingwise.com
Drivers License State
Drivers License
Member TIN
0
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Mike Jones
Title
VP
% of Ownership
25
Annual Salary/Compensation
0.000
Address
123 sw 12 ave
Phone
(136) 456-5463 Ext 4565
Cell
(645) 634-5634
SSN
554 - 54 - 5454
DOB
03/03/2022
Credit Score
Email
Drivers License State
Drivers License
Member TIN
0
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Drivers License State
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Corporate Secretary Name
Notes
Sales Method
Retail Swiped
%
KEYED
%
ECOMM
%
MOTO
%
Fee Schedule
Visa/MasterCard/Discover/AXP Qualified Credit Card Discount Rate(for Tiered/Flat) %
%
Visa/MasterCard/Discover/AXP Qualified Credit Card Pass Thru I/C Plus
%
Qualified Check Card Discount Rate (for Tiered/Flat)
%
Qualified Check Card PassThru I/C Plus
%
Visa/MasterCard/Discover/AXP
%
Authorization Fee
%
Monthly Program Fee "Cash Discount"
%
Customer Service Fee
%
Monthly Minimum Fee
%
PIN Debit Transaction Fee
%
Batch Fee
%
Amex OPT Blue Qualified Rate
%
Amex OPT Blue Mid Qual
%
Amex OPT Blue Non Qual
%
Amex OPT Blue Pass Thru I/C Plus
%
Amex ESA #
%
AVS Transaction Fee
%
EBT Transaction Fee
%
EBT Account#
%
Amex Processing Fee
%
Other Fee
%
3 Tier Pricing Visa/MC/Disc/AXP Mid Qual
%
3 Tier Pricing Visa/MC/Disc/AXP Non Qual
%
Chargeback Fee
%
ACH Retrieval Fee
%
Equipment Info
Are you currently using a point of sale system?
Software
Software Version
Does your Business have a Land Line?
How will your new terminal connect to the internet?
Does your business location(s) have internet?
Do you have WiFi?
Do you know the password?
What is your Wifi password?
%
Do you expect your EBT?
What is your EBT number?
%
What would you like to have printed on the bottom of the receipt?
%
Is the equipment for a restraunt?
Do you want Tips Added On?
Do you want the customer to fill out Tip on Receipt or at cashier when they checkout only?
Suggested % #1
%
Suggested % #2
%
Suggested % #3
%
Do you want your Terminal to automatically Batch out? (Not recommended for restraunts. Once it batches out, unentered Tips will be lost).
At What Time?
11:45:20 AM
Shipping Address
%
Shipping City
%
Shipping State
%
Shipping Zip Code
%
Additional Guarantors
Are there any additional guarantors?
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
General Guarantor Notes
HMDA - (Borrower)
Do you wish to furnish this information?
N/A
What is your Ethnicity:
Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
Not Hispanic or Latino
Not Disclosed
What is your Race:
American Indian
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
White
Not Disclosed
Sex:
Male
Female
Not Disclosed
Veteran
an option for veteran
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
HMDA - (Co-Borrower)
Do you wish to furnish this information?
N/A
What is your Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Not Disclosed
What is your Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Print Race
For example: Fijian, Tongan, and so on.
White
Not Disclosed
Sex:
Male
Female
Not Disclosed
Veteran
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
Borrower Background
Are you a U.S. Citizen?
No
Origin
Spain
Visa Status
Green Card status
Has the borrower been declared bankrupt within the past 7 years?
Yes
Status of Personal Bankruptcy
If Yes, identify the types of bankruptcy
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers?
Yes
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you?
Yes
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
No
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?
No
Status of Foreclosure
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee
No
(If Yes, Provide explanation below.)
Have you ever been convicted of a felony or other fraud related crimes?
No
(If Yes, Provide explanation below.)
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
(If Yes, Provide explanation below.)
Within the past 7 years, have you completed a pre-foreclosure sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?
Have you had property foreclosed upon in the last 7 years?
Have you previously had a short sale?
When was the short sale?
Please explain the circumstances of the short sale
Background Explanation
Income tax returns filed through
Are any returns currently being audited or contested?
what years (s)
Have you drawn a will?
Please furnish the name of the executor(s) and year will was drawn
Have you ever had a financial plan prepared for you?
Is there a line of credit or unused credit facility at any other institution(s)?
Please indicate where, how much, and name of banker
Do you anticipate any substantial inheritances?
Please Explain
Co-borrower Background
Are you a U.S. Citizen?
No
Origin
Visa Status
Has the borrower been declared bankrupt within the past 7 years?
NA
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers? (If Yes, Provide explanation below)
NA
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you?
NA
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
NA
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?
NA
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee
NA
(If Yes, Provide explanation below.)
Have you ever been convicted of a felony or other fraud related crimes?
NA
(If Yes, Provide explanation below.)
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
(If Yes, Provide explanation below.)
Background Explanation
Borrower Experience
Does borrower have Fix & Flip or Buy & Hold experience?
Yes
# of years of experience?
5
# of properties completed in last 36 months
10
List 3 examples of past deals:
Property Type
Single Family
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.000
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.001
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.002
Upload HUD
Does borrower have ground up construction experience?
Yes
# of years experience?
0
# of properties completed in last 36 months
0
Property Type
Purchase date
Purchase Price
0.00
Amount Financed
Rehab Budget
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
0.00
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.000
Upload HUD
Property Type
Purchase date
Purchase Price
0.00
Amount Financed
Rehab Budget
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
0.00
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.001
Upload HUD
Property Type
Purchase date
Purchase Price
0.00
Amount Financed
Rehab Budget
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
0.00
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.002
Upload HUD
Are you a builder/developer?
Do you have a GC on staff, or do you hire a third-party GC to complete rehab/construction?
Does borrower have experience selling properties without construction (e.g., wholesaling)?
# of years experience?
0
# of properties completed in last 36 months
0
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.000
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.001
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
0.00
Holding Title As
Ownership %
0.000
Ownership Status
Exit
Monthly Rent
Sale Price
Sale Date
Address
City
State
Zip
Unit/Suite #
Outcome/Profit
0.002
Upload HUD
Does borrower have any projects currently in progress?
Yes
How many?
5
Does borrower own investment properties?
Yes
How many?
2
Is borrower a member of an investment club or group?
NA
Name of Group/Club?
Do you have any professional licenses?
Yes
Select Professional license
General Contractor
License #
Are you a full time real estate investor?
How much liquid assets does borrower currently have?
1,500,000.00
Primary investment strategy
Residential fix & flip
Describe Your Overall Real Estate Investment Experience
Primary investment strategy Explain
Typical Transactions
Amount of financing requested
To
Amount of financing requested To
Typical purchase price
To
Typical purchase price To
Typical construction costs
To
Typical construction costs To
Typical sale price
To
Typical sale price To
No. of construction draws per project
0
To
No. of construction draws per project To
0
Months from purchase date to first construction draw
0
To
Months from purchase date to first construction draw To
0
Months from purchase date until construction complete
0
To
Months from purchase date until construction complete To
0
Months from purchase date to sale date
0
To
Months from purchase date to sale date To
0
No. of such projects that you will do at time
0
To
No. of such projects that you will do at time To
0
In which geographic areas do you intend to focus on the next 12-24 months?
Co-borrower Experience
Does borrower have Fix & Flip or Buy & Hold experience?
NA
# of years of experience?
0
List 3 examples of past deals:
Outcome/Profit
0
Upload HUD
0
# of properties completed in last 36 months
0
Address
Outcome/Profit
0
Upload HUD
0
Address
Outcome/Profit
0
Upload HUD
0
Does borrower have ground up construction experience?
NA
# of years experience?
0
List 3 examples of past deals:
Outcome/Profit
0
Upload HUD
0
# of properties completed in last 36 months
0
Address
Outcome/Profit
0
Upload HUD
0
Address
Outcome/Profit
0
Upload HUD
0
Does borrower have experience selling properties without construction (e.g., wholesaling)?
# of years of experience?
0
# of properties completed in last 36 months
0
List 3 examples of past deals:
Outcome/Profit
0.00
Upload HUD
Address
Outcome/Profit
0.00
Upload HUD
Address
Outcome/Profit
0.00
Upload HUD
Do you have any projects currently in progress?
NA
How many?
0
Does borrower own investment properties?
NA
How many?
0
Is borrower a member of an investment club or group?
NA
Name of Group/Club?
Do you have any professional licenses?
Select Professional license
License #
Are you a full time real estate investor?
How much in liquid reserves?
Primary investment strategy
Primary investment strategy Explain
SBA Questions
0.00
0.00
Purpose of the loan:
Detailed Explanation
Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Detailed Explanation
Have you been arrested in the past six months for any criminal offense?
Detailed Explanation
Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgement)?
Detailed Explanation
Has an application for the loan you are applying for now ever been submitted to SBA or to a Certified Development Company or lender in connection with any SBA program?
Detailed Explanation
Is the Applicant a franchise that is listed in the SBAs Franchise Directory?
Detailed Explanation
Does the Small Business Applicant have any Affiliates?
Detailed Explanation
Has the Small Business Applicant and/or its Affiliates ever filed for bankruptcy protection?
Detailed Explanation
Is the Small Business Applicant and/or its Affiliates presently involved in any pending legal action?
Detailed Explanation
Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?
Detailed Explanation
If you are at least a 50% or more owner of the applicant business, are you more than 60 days delinquent on any obligation to pay child support arising under an administrative order, court order, repayment agreement between the holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support enforcement services? .
Detailed Explanation
Has the Small Business Applicant and/or its Affiliates ever obtained a direct or guaranteed loan from SBA or any other Federal agency or been a guarantor on such a loan?
Is any of the financing currently delinquent?
Detailed Explanation
Did any of this financing ever default and cause a loss to the Government?
Detailed Explanation
Are any of the Small Business Applicants products and/or services exported or is there a plan to begin exporting as a result of this loan?
Provide the estimated total export sales this loan will support:
$
Is the Small Business Applicant using (or intending to use) a packager, broker, accountant, lawyer, etc. to assist in (a) preparing the loan application or any related materials and/or (b) referring the loan to the lender?
Detailed Explanation
Are any of the Small Business Applicants revenues derived from gambling, loan packaging, or from the sale of products or services, or the presentation of any depiction, displays or live performances, of a prurient sexual nature?
Detailed Explanation
No SBA employee, or the household member (see definition on page 1) of an SBA employee, is a sole proprietor, partner officer, director, or stockholder with a 10 percent or more interest, of the Applicant.
Detailed Explanation
No former SBA employee, who has been separated from SBA for less than one year prior to the request for financial assistance, is an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant.
Detailed Explanation
No member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government, is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or household member of such individual, of the Applicant.
Detailed Explanation
No Government employee having a grade of at least GS-13 or higher is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant
Detailed Explanation
No member or employee of a Small Business Advisory Council or a SCORE volunteer is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant.
Detailed Explanation
Have you, or any business you controlled, ever filed for bankruptcy protection?
Detailed Explanation
Is the United States the principal place of residence for all employees of the Applicant included in the Applicants payroll calculation above?
Detailed Explanation
Do any of your employees earn more than $100,000/year?
If Yes, Did you calculate your estimated monthly payroll using the cap of 100,000 per employee?
Detailed Explanation
Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and caused a loss to the government?
Detailed Explanation
Are you, or any business you control, presently involved in any legal action (including divorce)?
Detailed Explanation
Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020?
Loan Amount
$
Detailed Explanation
Detailed Explanation
Add Other Business Info
How many W-2 Employees do you have?
0
How many W-2s did you issue for 2020?
0
When was your company started?
Did you operate under full or partial suspension due to government order?
How your business was impacted during the partial or full shutdown
What quarters were you affected? (If not sure leave blank)
Please provide gross receipts of each quarter excluding any PPP funds if they are included as revenue
Q1 2019
Q2 2019
Q3 2019
Q4 2019
Q1 2020
Q2 2020
Q3 2020
Q4 2020
Q1 2021
Q2 2021
Q3 2021
Q4 2021
Did any of your vendors operate under full or partial suspension due to government order that affected your ability to do business?
How your business was impacted during the partial or full shutdown
What quarters were you affected due to vendor delays
Please provide gross receipts of each quarter excluding any PPP funds if they are included as revenue
Q1 2019
Q2 2019
Q3 2019
Q4 2019
Q1 2020
Q2 2020
Q3 2020
Q4 2020
Q1 2021
Q2 2021
Q3 2021
Q4 2021
In 2020, which quarters experienced losses of at least 50% relative to the same quarter in 2019? If not, sure please leave blank
In 2021, which quarters experienced losses of at least 20% relative to the same quarter in 2019? If not sure, please leave blank
If you did receive a PPP loan(s), what was the amount(s)?
Draw 1
Draw 2
If you received a PPP loan(s), did you receive PPP loan forgiveness?
Draw 1
Draw 2
If you did have PPP loan forgiveness, what was the forgiven amount(s)?
Draw 1
Draw 2
Who is your payroll service provider?
Have you already claimed any Employee Retention Credits?
If Yes, which quarter(s) and with which company?
Are any employees that are family members or 50%+ owners? If so, please provide names
Have you started any other businesses since Feb 15th 2020 with annualized revenues of less than $1,000,000 and that has active W-2 employees?
Do you have any other existing businesses with active w-2 employees? If yes, please let business entity names and number of W-2 employees
Assets (Include Borrower + Co-borrower)
Type
Estimated Value ($)
Amount Owed ($)
Cash
$
$
Checking Account(s)
$
Savings/Money Market/ CDs
$
Net worth of business(es) owned
$
Accounts & Notes Receivable
$
Accounts & Notes Receivable Owed
$
Stocks/Bonds
$
Stocks / Bonds Owed
$
Non-Marketable Securities
$
Non-Marketable Securities Owed
$
IRA / Keogh Accounts
$
IRA / Keogh Accounts Owed
$
401k / ESOP Accounts
$
401k / ESOP Accounts Owed
$
Life Insurance -- Cash Surrender Value Only
$
Life Insurance Owed
$
Total cash in bank accounts
Total value of retirement accounts
$
Availability under lines of credit
Line of Credit Owed
$
Home
$ 500,000.00
Home Owed
150,000.00
Secondary Residences
$
Secondary Residences Owed
$
Other Real Estate
$750,000.00
Other Real Estate Owed
$ 500,000.00
Cars
$
Cars Owed
$
$
$
Other Personal Property
$
Other Owed
$
Other Assets
$
Notes Payable to Banks & Others
$
Installment Account(s)
$
Revolving Debt
$
Unpaid/Payable Taxes
$
Secured Notes Payable to this Bank
$
Unsecured Notes Payable to this Bank
$
Accounts Payable (including credit cards)
$
Margin Accounts
$
Other Liabilities Owed
$
Other Assets Details
0
Other Liability Details
Unpaid Taxes Details
Total:
$
1,250,000.00
$
650,000.00
Total Est. Value
- Total Amt Owed
= Total Net Worth
$
1,250,000.00
- $
650,000.00
= $
600,000.00
Gifts or Grants
Gifts Or Grants : 1
Asset Type
Deposited/Not Deposited
0
Source
Cash Or Market Value
Schedule of Real Estate Owned and Sold
123 main street, Miami, Florida
Property Address
123 main street
Property Unit#
Property City
Miami
Property State
FL
Property Zip
33333
Property Country
Status
Pending Sale
Ownership %
Type Of Property
1
Investment Type
Present Market Value
250,000.00
Balance of Mortgages & Liens
125,000.00
Gross Rental Income
5,000.00
Mortgage Payments
2,500.00
Insurance, Taxes, HOA (If Not Included in Payment)
875.00
Net Rental Income
Titled Under
flips r us
12/07/2020
Purchase Price
175,000.00
Value of Improvements Made
28,000.00
Intended Occupancy
Investment
Sale Price
Are there any mortgages or liens?
No
Creditor Name
Account Number
Loan Status
Monthly Payment
Interest Rate
0.000
Unpaid Balance
Type
Credit Limit
To be Paid off at or before closing
0
Maturity Date
Is their another mortgage or lien?
Creditor Name
Account Number
Loan Status
Monthly Payment
Interest Rate
0.00
Unpaid Balance
Type
Credit Limit
To be Paid off at or before closing
0
0
456 tuttle street, Davie, Florida
Property Address
456 tuttle street
Property Unit#
Property City
Davie
Property State
FL
Property Zip
33221
Property Country
Status
Rental
Ownership %
Type Of Property
1
Investment Type
Present Market Value
450,000.00
Balance of Mortgages & Liens
250,000.00
Gross Rental Income
3,900.00
Mortgage Payments
2,485.00
Insurance, Taxes, HOA (If Not Included in Payment)
1,200.00
Net Rental Income
Titled Under
flips r us-2
12/28/2021
Purchase Price
259,000.00
Value of Improvements Made
55,000.00
Intended Occupancy
Investment
Sale Price
Are there any mortgages or liens?
Creditor Name
Account Number
Loan Status
Monthly Payment
Interest Rate
0.000
Unpaid Balance
Type
Credit Limit
To be Paid off at or before closing
0
Maturity Date
0
Is their another mortgage or lien?
Creditor Name
Account Number
Loan Status
Monthly Payment
Interest Rate
0.00
Unpaid Balance
Type
Credit Limit
To be Paid off at or before closing
0
0
Borrower Employment Information
Position or Title
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Start Date
Nature of Employers Business
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
$
How often are you paid?
Weekly
Monthly
Every 2 weeks
Twice a month
Employer Information
Employer Name
Years at job
Employer Address
Employer City
Employer State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Please explain if employment history is less than 2 years
Employer Phone
May we contact you at work?
Years employed in this line of work / profession
Additional Employment Information :
1
Is this job an additional or previous Job?
Additional
Previous
Name
Address of Employer
Employer City
Employer State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Country
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
I have ownership share of less than 25%
I have ownership share of less than 25%
Monthly Income/Loss $
Employed From
Employed To
Yrs employed in this line of work / profession
Employed by a family member, property seller, real estate agent, or other party to the transaction?
Are you the business Owner or Self-Employed?
Monthly Income
Overtime
Commission/Bonus
Military Entitlements
Other
Income from other sources
Alimony
Child Support
Interest and Dividends
Notes Receivable
Royalty Payments
Unemployment
Automobile Allowance
Disability
Mortgage Credit Certificate
Public Assistance
Separate Maintenance
Benefits
Boarder Income
Foster Care
Mortgage Differential
Retirement
Social Security
VA Compensation
Capital Gains
House or Parsonage
Payments
Trust
Other
Total Monthly Income from Other Sources
Position / Title / Type of Business
Employer Phone
Co-borrower Employment Information
Position or Title
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Start Date
Nature of Employers Business
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
$
How often are you paid?
Weekly
Monthly
Every 2 weeks
Twice a month
Employer Information
Employer Name
Years at job
Employer Address
Employer City
Employer State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Phone
May we contact you at work?
Years employed in this line of work / profession
Additional Employment Information :
1
Name
Address of Employer
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
Employed From
Employed To
Are you the business Owner or Self-Employed?
Monthly Income
Position / Title / Type of Business
Employer Phone
Borrower Monthly Income
Base Employment Income
$
Commission/Bonus
$
Military Entitlements
$
Overtime
$
Net Rental
$
Dividends / Interest
$
Capital Gains / (Losses)
$
Partnership / Subchapter S Income
$
Other
$
Other Income Description
Total Income
$
9,000.00
(Borrower)
Co-borrower Monthly Income
Base Employment Income
$