EmailMe Form - Elevation One Group

Contact Information

Name *

First Last

Email *

Phone Number *

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

Are you a U.S. Citizen? *

Yes

No

What state do you live in?

Date of Birth

MM / DD / YYYY

What amount of funding are you requesting? *

Purpose of loan? *

When do you need the money? *

What's your credit score? *

Get access to your credit score for $1 at http://bit.ly/idiqcreditscore

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

Yes

No

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

Yes

No

Do you have a minimum of 3 established trade lines that are at least 6 months old? *

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 negative items reporting on your credit report in the last 2 years?
(Judgement, Child Support, Late Payments, Collections, Bankruptcy, Evictions, Medical Bill, Foreclosure, Charge-offs, Pre-Foreclosure) *

Yes

No

Are your credit card balances 60% or less? *

Yes

No

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

Yes

No

Are you employed or self-employed ? *

Full time employee

Self-employed only

Employed and also own a business

I am retired

Are you earning a minimum of $27,000 per year? *

Yes

No

If employed, are you currently on any paid leave of absence or laid off with your employer?

Yes

No

If Retired or receiving Social Security…

Do you have an awards letter?

Yes

No

How did you hear about us?

How did you hear about us? *

Instagram

Facebook

Referral

Other

Referral Name

First Last