EmailMe Form - EMG Business Capital Funding

Your Name *

First Last

Your Phone #- Best # to reach you to review your funding inquiry form? *

### - ### - ####

Can we text you? *

Yes

No

Your Email *

Are you a U.S. Citizen? *

Yes

No

How soon do you want the money? *

What amount of funding are you requesting? *

What is the purpose of the loan? *

Provide details of your project here. *

How long have you been in business? *

What type of entity is your business registered as? C-corp, S-corp, Sole Proprietor? *

Did you file the last 2 years of taxes? *

What is your monthly minimal adjusted gross income? (Take home income after all expenses paid) *

What is your monthly gross income? *

Do you have a credit score of 500 or higher? *

Yes

No

What are you scores? You must list ALL 3 scores. *

Do you have NEW credit lines opened in the last 6 months (Credit Cards, Credit Card Limit Increase, Car Loan, Mortgage, personal loans or etc? *

Yes

No

List them here and give amounts.

When are each of these expected to be paid off?

How many inquiries do you have in the last 6 month?

Have you ever filed bankruptcy? *

Yes

No

If so, how long ago?

Has it been discharged?

Do you have any late payments, recent collections, or anything that is derogatory reporting in the last 24 months? *

Yes

No

How long ago did they last report?

How many inquiries do you have in the last 6 months? *

Do you currently have any fraud alerts on your credit report? *

Yes

No

Do you have more than 3 insufficient funds in your business account, in any of the last 4 months? *

Yes

No

How did you hear about us? *

Facebook

Instagram

Referral

Other

If you were referred, please provide the name and phone number of the person who referred you. (If not referred, type NA) *

Provide us with the best days and times you wish to be contacted. *

Additional information you wish to share.