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Borrow Funds Preliminary Questionnaire
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1.
Contact Information
(Required.)
Name
*
Address
*
Address 2
City/Town
*
State/Province
*
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
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Country
Email Address
*
Phone Number
*
*
2.
What amount of funds are you seeking?
(Required.)
$10,000 or less
$10,000-$100,000
$100,000-$250,000
$250,000-$1,000,000
$1,000,000+
3.
What will the funds be used for?
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4.
What amount of your own funds will be used in this transaction?
(Required.)
I am not planning on using any of my funds.
$1-$10,000
$10,000-$100,000
$100,000-$250,000
$250,000-$1,000,000
$1,000,000+
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5.
What is your timing for this investment?
(Required.)
Within the next 14 days.
Within the next 30 days.
Within the next 60 days.
Later than 60 days.
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6.
What is your approximate credit score?
(Required.)
Less than 669
670-739
740-799
800-850
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7.
What collateral is available to secure the loan?
(Required.)
No collateral available.
Collateral available.
Please explain available collateral.
8.
Feel free to provide additional detail.