Business Information
Business Type *
Select… Corporation LLC Sole Proprietorship Other
Federal Tax ID *
Legal Name: *
DBA Name: *
Address: *
Address 2:
City: *
State: *
ZIP: *
Business Phone: *
Business Fax:
Website:
Email:
Business Inception Date: *
Business Purchase Date:
# Of Locations: *
Do you have the NAICS/NICS Industry Code? Select… Yes No
Is this business for sale? Select… Yes No
Do you own or rent? *
Financial Information
Gross Annual Sales:*
Average Bank Balance:*
Monthly Credit Card Vol.:
Desired Funding Amount:*
Desired Term:
Select 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months
11 Months
12 Months
Use of Funds:*
Select… Business Expansion Capital / Facilities Improvements Equipment Purchase Inventory, Merchandise, or Specified Goods New Location Sales Transaction Financing Services (e.g. training) Debt Refinancing Insurance Payables
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Independent Funding Advisory 