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Loan Request Form - New - Borrowers - Scoring
First Name *
*
Last Name
*
Email Address
*
Phone
*
Job Title
*
Name of Business (requesting loan)
*
Business Address
*
County
*
# of Employees
*
Entity Type
*
Select Entity Type
Corporation
Limited Liability Company
Partnership
Sole Proprietorship
Not Filed
Business Type
*
Select Business Type
Volunteer Fire Department
Municipal Fire Department
Agriculture, Forestry, Fishing and Hunting
Arts, Entertainment, and Recreation
Adult Entertainment
Gambling
Automobile Dealers & Parts
Construction
Education
Finance and Insurance
Healthcare
Social Assistance
Investment Property
IT, Media, or Publishing
Legal Services
Multi-Family Property
Mining (except Oil and Gas)
Oil and Gas Extraction
Political, Governmental, or Public Organizations
Commercial Real Estate
Religious Organizations
Restaurants and Food Services
Retail Stores
Firearm Sales
Gas Stations
Freight Trucking
Travel Agencies
Utilities
Wholesale Trade
All Other
Time in Business
*
Business Years in Operation *
Forming LLC for Real Estate
0 - 2 Months
3 - 5 Months
6 - 11 Months
1 - 2 Years
2 - 3 Years
3 - 5 Years
5 or More Years
Monthly Revenue
*
Monthly Revenue *
$0, No Revenues
$1 - $4,000
$4,001 - $8,000
$8,001 - $15,000
$15,001 - $20,000
$20,001 - $40,000
$40,001 - $80,000
$80,001 - $200,000
$200,001 - $400,000
More Than $400,000
Have you filed bankruptcy within the last 7 years?
*
Have you filed bankruptcy within the last 7 years? *
No
Yes
How's Your Personal Credit Score?
*
How's Your Personal Credit Score? *
(499 or Below) Poor
(500 - 599) Not so Good
(600 - 649) Okay
(650 - 679) Good
(680 - 719) Great
(720 or Higher) Excellent
Loan Purpose
*
Loan Purpose *
Equipment Loan
Commercial Real Estate
Multi-Family Property
Commercial/Business Vehicle
Purchase a Business
Purchase a Franchise
Working Capital
Finance Accounts Receivable
Payroll
Expansion
Start a Business
Buy Out a Partner
Loan Request Amount
*
Loan Request Amount *
$1 - $5,000
$5,001 - $25,000
$25,001 - $50,000
$50,001 - $100,000
$100,001 - $250,000
$250,001 - $500,000
$500,001 - $1M
Over $1M
Loan Officer Name (if applicable)
By checking this box, I agree to the terms of use and authorize Finance Responders to forward information as stated in the
terms and conditions
to lending sources to help my business secure financing.
By checking this box, I agree to the terms of use and authorize njBIZloan Connection, LLC to forward information as stated in the terms and conditions to lending sources to help my business secure financing.
*
I agree.
Submit
If you are human, leave this field blank.
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