Quick Application Form

Quick Submission

What kind of program are you looking for?

SBA Loan product

Additional Desired Loan programs

Where are you in the process?

Lead Source

Borrower Info

First Name

Middle Name

Last Name

Borrower Email

Please Wait...

Secondary Email

Home Phone

Cell Phone

Fax

Cell Carrier

Preferred Communication

Is there a Co-borrower?

Alt. Phone #

Work Phone #

Address

Unit #

City

State

Zip Code

County

Country

Length of time at the present property

Length Of Time At The Present Property Months

Rent or Own

Rent Per Month Current Address

Has the borrower resided at the present address for less than two years?

Yes No

Previous Address

Previous Unit #

Previous City

Previous State

Previous Zip Code

Previous Country

Length of time at the previous property

Length Of Time At The Previous Property Months

Rent or Own

Rent Per Month Previous Address

Mailing Address

Mailing Address same as Current Address?

Mailing Address

Mailing Address Unit#

Mailing City

Mailing State

Mailing Zip Code

Mailing Address Country

Alternate Names

Alternate Section 1

First Name

Personal Info

Date Of Birth

Place Of Birth

Social Security Number

Driver License State

Driver License Number

Marital Status?

Unmarried Married Separated

Date of Marriage

Date of Divorce (If applicable)

Maiden Name

Full name of Spouse if not on mortgage

Citizenship

U.S. Citizen Perm Resident Non-Perm Resident

Did you ever serve, OR are currently serving IN the United States Armed Forces?

Yes No

Servicing member Info

Projected Expiration Date of Service/Tour

Ages Of Dependents

Number Of Dependents

Mid Credit Score

Equifax Score

Transunion Score

Experian Score

Credit Score Range

Co-borrower Information

First Name

Last Name

Email Address

Please Wait...

Home Phone

Cell Phone

Fax

Mobile Service Provider

Same as borrowers address?

Address

City

State

Zip Code

Rent or Own

Is the Co-Borrower Guaranteeing the loan?

Yes No NA

Length of time at address

Has the borrower resided at the present address for less than two years?

Yes No

Previous Address

Previous City

Previous State

Previous Zip Code

Rent or Own

Mailing Address

Same as borrowers mailing address?

Mailing Address

Mailing City

Mailing State

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?

Unmarried Married Separated

Married to Borrower?

Yes No

Citizenship

U.S. Citizen Perm Resident Non-Perm Resident

Equifax Score

Mid Fico Score

Transunion Score

Experian Score

Credit Score Range

Borrower Type/Entity Info

Borrower Type

Trust Type

Retirement Entity

General Business Info

Entity Name

Trade Name/DBA

Entity Type

Date Of Formation

Time in Business

State Of Formation

States Registered In

Federal Tax ID/EIN

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

Address 2/Suite/Unit #

City

State

Zip Code

Is the billing address the same as above?

Billing Address

Billing City

Billing State

Billing Zip Code

Location

Urban Rural Suburban

Property Ownership

Value of Property?

Total Debt on Property?

Name of Lender(s)?

Landlord/Mortgage Contact Name

Landlord/Mortgage Phone

Rent/Mortgage Payment

Business Details

Business Type

# of employees currently

# of employees after loan

Business Category

Type of product or service sold

Naics Code

NAICS Code look up

Does your business sell a

Service Product

Is your Business

B2B B2C

Is your business home based?

Yes No

Do you take credit card payments?

Yes No

Terminal/ POS Make/Model

How many card processor banks do you have active?

Merchant Processing Bank Name(s)

Do you charge sales tax?

Yes No

How are employees paid?

Do you have more than one business location?

Yes No

How many locations?

Other Location Details & Addresses

Is the business a franchise?

Yes No

Name of Franchise

Point of Contact

Point of Contact Phone

Point of Contact E-mail

Website for Franchise

is your business seasonal?

Yes No

if Yes, what are the peak months?

Business Description

Do you have Business Reference(s)?

Yes No

Phone Name

Company

Fax

Business Financials

Average Monthly Credit Card Sales

Average Monthly Deposits

Annual Revenue

Annual Gross Profit

YTD-Net Business Income

Date of Operating Agreement

Gross Annual Revenues $

Gross Income Last Year

Net Income Last Year

Gross Income 2 years ago

Net Income 2 years Ago

Average Bank Balance

Has business ever filed for bankruptcy?

Yes No

Status of Business Bankruptcy

Recent NSFs

Does your business owe taxes for years prior to the current year?

Yes No

Estimated amount owed

Members/Officers (List all members with 20% ownership or more.)

Name

Title

% of Ownership

Annual Salary/Compensation

Address

Phone

Cell

SSN

DOB

Credit Score

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

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

Add More Members/Officers Info

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?

Yes No

Software

Software Version

Does your Business have a Land Line?

Yes No

How will your new terminal connect to the internet?

Does your business location(s) have internet?

Yes No

Do you have WiFi?

Yes No

Do you know the password?

Yes No

What is your Wifi password?

Do you expect your EBT?

Yes No

What is your EBT number?

What would you like to have printed on the bottom of the receipt?

Is the equipment for a restraunt?

Yes No

Do you want Tips Added On?

Yes No

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).

Yes No

At What Time?

Shipping Address

Shipping City

Shipping State

Shipping Zip Code

Additional Guarantors

Are there any additional guarantors?

Yes No

First Name

Middle Name

Last Name

Phone #

Cell

SSN

Date Of Birth

Marital Status?

Address

City

State

Zip

Credit Score

Citizenship

U.S. Citizen Perm Resident Non-Perm Resident

Guarantor Notes

General Guarantor Notes

Not Used - HMDA - (Co-Borrower)

Do you wish to furnish this information?

Yes No N/A

What is your Ethnicity:

Hispanic or Latino

Mexican, Puerto Rican, Cuban, Other Hispanic or Latino

Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on

Not Hispanic or Latino Not Disclosed

What is your Race:

American Indian or Alaska Native Asian

Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian

Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Race For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Black or African American Native Hawaiian or Other Pacific Islander

Native Hawaiian, Guamanian or Chamorro, Samoan, 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 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?

Yes No N/A

What is your Ethnicity:

Hispanic or Latino

Mexican, Puerto Rican, Cuban, Other Hispanic or Latino

Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on

Not Hispanic or Latino Not Disclosed

What is your Race:

American Indian or Alaska Native Asian

Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian

Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Race For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Black or African American Native Hawaiian or Other Pacific Islander

Native Hawaiian, Guamanian or Chamorro, Samoan, 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?

Yes No

Origin

Visa Status

Has the borrower been declared bankrupt within the past 7 years?

Yes No

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 No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?

Yes No

(If Yes, Provide explanation below.)

Have you had or currently have any property tax liens?

Yes 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?

Yes 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

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes 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?

Yes No

(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?

Yes No

Have you had property foreclosed upon in the last 7 years?

Yes No

Have you previously had a short sale?

Yes No

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?

Yes No

what years (s)

Have you drawn a will?

Yes No

Please furnish the name of the executor(s) and year will was drawn

Have you ever had a financial plan prepared for you?

Yes No

Is there a line of credit or unused credit facility at any other institution(s)?

Yes No

Please indicate where, how much, and name of banker

Do you anticipate any substantial inheritances?

Yes No

Please Explain

Co-borrower Background

Are you a U.S. Citizen?

Yes No

Origin

Visa Status

Has the borrower been declared bankrupt within the past 7 years?

Yes No

Please provide filing date, current status, properties included, etc...

Are there any outstanding judgments against the borrowers? (If Yes, Provide explanation below)

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?

Yes No

(If Yes, Provide explanation below.)

Have you had or currently have any property tax liens?

Yes 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?

Yes No

(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

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes 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?

Yes No

(If Yes, Provide explanation below.)

Background Explanation

Borrower Experience

Does borrower have Fix & Flip or Buy & Hold experience?

Yes No

# of years of experience?

# of properties purchased and/or sold in last 36 months

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Holding Title As

Ownership %

Ownership Status

Exit Monthly Rent

Sale Price

Sale Date

Address
City
State
Zip
Unit/Suite #

Outcome/Profit

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Holding Title As

Ownership %

Ownership Status

Exit Monthly Rent

Sale Price

Sale Date

Address
City
State
Zip
Unit/Suite #

Outcome/Profit

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget