Quick Application Form

Are you a referral Partner or Working with One?

Yes No

Email Address

First Name

Last Name

Company Name

Phone Number

What kind of program are you looking for?

Broker/Referring Party

Authorized Signer

First Name

Last Name

Please Wait...

Cell Phone

Is there a Co-signer?

Address

City

State

Zip Code

Yes No

Mailing Address

Personal Info

Date Of Birth

Social Security #

Social Security Number

Unmarried Married Separated

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Yes No

Currently serving on active duty Currently Retired, discharged, or separated from service Non-activated member of the Reserve or National Guard Surviving Spouse

Co-Signer Information

First Name

Last Name

Email Address

Please Wait...

Cell Phone

Address

City

State

Zip Code

Yes No

Mailing Address

Personal Info

Date Of Birth

Social Security Number

Unmarried Married Separated

Yes No

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Credit Score Range

Business Entity

General Business Info

Entity Name

Entity Type

Date Of Formation

Time in Business

State Of Formation

Website Address

Business Address

Address

City

State

Zip Code

Urban Rural Suburban

Business Details

Business Category

Type of product or service sold

Naics Code

NAICS Code look up

Service Product

B2B B2C

Yes No

Business Financials

Yes No

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

Add More Members/Officers Info

Additional Guarantors

Yes No

HMDA - (Borrower)

Yes No N/A

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

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

Male Female Not Disclosed

an option for veteran

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

HMDA - (Co-Borrower)

Yes No N/A

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

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

Male Female Not Disclosed

an option for veteran

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Owner/Signer Background

Yes No

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

Yes No

Status of Personal Bankruptcy

Are there any outstanding judgments against the owners?

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?

Yes No

(If Yes, Provide explanation below.)

Yes No

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.)

Has the borrower been declared bankrupt within the past 7 years?(If Yes, Do NOT proceed with application)

Yes No

Background Explanation

Co-Signer Background

Are you a U.S. Citizen?

Yes No

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

Yes No

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.)

Yes No

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.)

Yes No

Borrower Experience

Yes No

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit Monthly Rent

Sale Price

Sale Date

Address
City
State
Zip

Outcome/Profit

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit Monthly Rent

Sale Price

Sale Date

Address
City
State
Zip

Outcome/Profit

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit Monthly Rent

Sale Price

Sale Date

Address
City
State
Zip

Outcome/Profit

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Yes No

Typical Transactions

Co-borrower Experience

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Yes No

Additional Information

Payroll Rent/Mortgage Interest Utilities Other

Detailed Explanation

Yes No

Have you, or any business you controlled, ever filed for bankruptcy protection?

Yes No

Detailed Explanation

Yes No

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?

Yes No

Detailed Explanation

Are you, or any business you control, presently involved in any legal action (including divorce)?

Yes No

Detailed Explanation

Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020?

Yes No

Loan Amount

Detailed Explanation

Is the Applicant or any owner of the Applicant Business an owner of any other business/affiliate, or have common management with, any other business/affiliate?

Yes No

Detailed Explanation

Other Business/Affiliate Information

Company Name

Tax Id/EIN #

Legal Owners/Title/Ownership %

# of employees

Years in Business

Has applied for SBA loans?

Yes No

Description

Add Other Business Info

How many W-2 Employees do you have? (1099 employees DO NOT qualify for ERTC)

How many quarters are you requesting an advance for?

When was your company started?

Did you operate under full or partial suspension due to government order?

No Partial Suspension Full Suspension

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?

No Partial Suspension Full Suspension Not Sure

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