EmailMe Form - Funding Mentorship

Contact information

Name *

First Last

Email *

Phone Number *

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

Social Security Number *

Are you a U.S. Citizen? *

Yes

No

How did you hear about us? *

Referral Name

First Last

What amount of funding are you requesting? *

Purpose of loan? *

What is your credit score? *

680 or higher

650 - 680

600 -650

under 600

Are you employed, self-employed, or retired *

Employed

Self-Employed

Employed and Self-Employed

Retired

Do you earn a minimum of $27,000 adjusted gross income per year? *

Yes

No

Do you have less than 6 hard inquiries in the last 6 months? *

Yes

No

Do you have new credit lines opened in the last 6 months? *

Yes

No

Do you have at least 60% left on your current credit card balances? *

Yes

No

Have you ever filed Bankruptcy? *

Yes

No

If you have filed for Bankruptcy has it been discharged for 2 years or more?

Yes

No

Do you have any late payments, collections, or judgements reporting on you credit report in the past 2 years? *

Yes

No

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

Yes

No