Loans and Lines of Credit Form

* = Required Information

Time in Business

Annual Revenue

Rate your Business Credit

Employment

Name of Employer *

Street Address

Suite

City

State

Zip Code

Phone *

Extension

Supervisor Name *

Phone

Extension

Employer's Email *

Web Address

Occupation?

Annual Income

Self-Employed Business

Rate your Business Credit

Business Full Legal Name

Business Legal Status

Street Address of Business

Suite

City

State

Zip Code

Phone *

Fax *

Extension

Web Address

What industry are you in?

Is your business home based?

Yes

Ownership Percentage

Does the Business Have Established Credit?

Yes

Equifax Score?

Experian Score?

DnB Score?

Paynet Score?

Amount Requested?

Type of Funding Requested

Business Banking

Amount Requested?

Where does the Company Bank?

Current balance in the Bank Account?

Amount Deposited Last Month?

Number of Deposits

Ending Balance?

Amount Deposited Prior Month?

Number of Deposits

Ending Balance?

Amount Deposited Prior Month?

Number of Deposits

Ending Balance?

Loan Purpose

When do you need Funding?

Corporate Status

Business Start Date

Formation Date

State of Formation

Owner's Information

Owner's Name *

Title *

Home Address

Street

Apartment

City

State

Home Phone *

Best Hours of Contact

Cell Phone *

Best Hours of Contact

Email *

Have you ever file a bankruptcy?

Yes

When

Income Filed on Year End Tax Returns

Year to Date Income

Social Security Number ?

Owner Date of Birth

Credit Build is not the Direct Lender or Broker, we have a celebrative relationship with Lenders, Brokers and Investors. The loan specialist will be contacting you directly.