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Finance Blueprint
FORM COMPLETED BY BUSINESS OWNER ONLY
Client Agent:
Stacey
* Personal Credit Score:
Below 620
620 - 679
Above 680
* House Hold Income
One Resident
Two Residents
Three Residents
Four Residents
* Yearly House Hold Income:
$5,000 - $15,000
$15,000 - $25,000
$25,000 - $50,000
$50,000 - $100,00
$100,000 - $200,00
* How Will You Use the Financing?
Buy Equipment
Hire Employees
Expansion / Remodel
Purchase Inventory
Refinance Debt
Marketing
Other
* Date Business Started:
* Business Structure
Not yet established
Corporation (S or C)
LLC / LLP
Partnership
Sole Proprietor
Non Profit
* Date of Birth:
* Business Rent or Own:
Rent
Own
* Outstanding Invoices with Businesses:
N / A
Under $10,000
$10,000 - $30,000
$30,000 - $50,000
$50,000 - $100,000
$100,000 +
* Amount of Outstanding Purchase Orders (PO)
N / A
* Own Revenue Generating Real Estate:
Yes
No
* Business Owner has a 401K?
Yes
No
* Is There More Than 1 Business Owner?
Yes
No
Please Include:
1. Three Months Business Bank Statements
(Email to info@QuicKapital.com)
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