Intake Form – Equipment Financing Company Name*Contact Name*Contact Email* Contact Phone Number*Ownership Structure Names and PercentagesBusiness Start Date Month Day Year Business Name and TypeBusiness LocationBusiness WebsiteStory/Background of BusinessAmount of Funding RequestedEquipment Type & VendorTimeline For FundingHow will the funding be applied to make the business more profitible?Financial Results to date2018 Gross Revenue2018 Net Profit or Loss2019 Gross Revenue2019 Net Profit or Loss2020 Gross Revenue2020 Net Profit or LossBalance Sheet ItemsAccounts Receivable ValueCashReal Estate Value Minus Loans and / Type of Real EstateEquipment Value Minus LoansInventory Value ( Non Thc products)Current Business DebtGuarantor InformationCredit Score, Net Worth, Average Three Year IncomeCurrent Product Demand and Purchase Orders (if applicable)Do you have a IRA or 401K from an employer you are no longer with?YesNoIf yes amount in that?Do you have jewelry, machinery, vehicles, gun or art collection or any other items of value to provide as collateral for a loan?YesNoIf so type of asset and value?How did you learn about us?Any additional files you would like us to see please upload here:Max. file size: 50 MB.EmailThis field is for validation purposes and should be left unchanged. Δ
