Business Funding
Name of your Business
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Consultant Name or Rep ID# Who referred you?
Please select which product(s) you are interested in receiving a free assessment and/or additional Information
Business Credit (assessment available)
Business Funding (assessment available)
Business Debt Elimination (assessment available)
Digital Marketing Services (assessment available)
Incorporating Services (assessment available)
Discount Medical & Dental Savings Program
1. What kind of Business do you operate?
2. What industry does your comapny participate in?
3. Month and year business was started:
4. Is your business home-based?
No
Yes
5. How is your business classified?
Sole Proprietor
Incorporated
6. Incorporate State:
7. How many employees do you have?
8. Is there a bank account in the business name?
No
Yes
9a. What are the gross sales of the business Per Year?
(USD Amount)
9b. What are the gross sales of the business Per year?
(EUR Amount)
10. Can you show 2 years of financial’s for your business with good profits?
No
Yes
11. Do you know your personal credit scores?
No
Yes
If so, what are they?
(Enter each below)
Equifax
Experian
Trans Union
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12. Do you presently own real estate?
No
Yes
If so, what is the current market value of the property(ies)?
13. What is currently owed against the property(ies)?
14. Do you accept credit cards?
No
Yes
If yes, how much do you process each month in credit cards?
(USD Amount)
Would you like a FREE Analysis to determine if we can lower your merchant processing rates?
No
Yes
15. Do you have any business assets such as:
Equipment
Inventory
Purchase Orders
Account Receivables
16. Amount of outstanding invoices with customers:
(USD Amount)
17. Current amount of existing purchase orders:
(USA Amount)
18. total value of equipment owned outright:
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19. Do you have a breakdown for usage of funding?
No
Yes
If so, please list usage & amount:
20. Do you have aretirement/401K plan?
No
Yes
21. Total Value of IRA & 401K investments:
(USD Amount)
22. How much funding mare you seeking?
(USD Amount)
23. Is your business a for profit or non-profit business
24. How quickly do you need funding?
25. Would you like to receive additional information?
No
Yes
26. Do you currently have an online digital marketing partner to manage your online and social media presence?
No
Yes
27. Would you like a free debt reduction analysis to determine the quickest and most cost effective way to become debt free and receive your “Debt free” Date
No
Yes
28. If No would you like to receive a complimentary digital marketing evaluation for your businessses goals.
No
Yes
Best method and time to contact you
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Text
No
Yes
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Hour
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Minutes
AM
PM
AM/PM Option
Attachments
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