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Commercial Credit Screening Intake

This form is used solely to determine whether a capital request may be appropriate for private commercial lending.


We do not raise capital, solicit investors, or guarantee financing outcomes. All information provided is self-reported and used for screening and introduction purposes only.

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What’s your company name?

Contact Name & Title

Email Address

Phone Number

Business Entity Type

Business Entity Type
A
B
C
D
E

How long has this entity been in Business?

State of Business Formation

Industry / Business Description

Have you operated in this Industry before?

Have you operated in this Industry before?
A
B

Deal Size (Total Capital Requested)

Use of Funds

How does this use of capital support revenue

Current Cash Flow Status

Current Cash Flow Status
A
B
C

What is this company Adjusted EBITDA

Collateral Available

Collateral Available

Collateral Description

How much equity capital is currently invested to date?

Is additional equity available if required?

Is additional equity available if required?
A
B

Credit Flags

Credit Flags

Approximate personal credit Score?

If any credit issues were selected, please explain

Borrower / Management Experience

Is the borrower willing to provide a personal guarantee if required?

Is the borrower willing to provide a personal guarantee if required?
A
B
C

Is this a commercial loan request (not a securities transaction)?

Is this a commercial loan request (not a securities transaction)?
A
B
C

Is the capital request coherent and clearly defined?

Is the capital request coherent and clearly defined?
A
B
C

Acknowledgement

Acknowledgement
Thank you!