1. First Name:_______________________
cell ____ work ____
Email Address: ____________________________________________________________
Type Of Business (I.E. Automotive, restaurant, Investment ) ___________________________
Type of Entity: (I.E. S-Corp, LLC) _____________________________________________
When Did You Incorporate? _________________________________________________
S U
$50k ____ $75k ____ $100k ____ $150k ____ $200k _____ Other: ____________
Do you currently have any business credit cards? (If so, please list bank/lender, balance, and credit limit)
Bank Balance Limit
Legal Business Name: __________________________________________________________
Last Name: _______________________________
About Your Business
(mark "x" in appropriate field)
Contact Information
PREQUALIFICATION FORM
Home Address: ______________________________________ Zip:____________________
City:____________________________________ State:__________________________
Phone Number: _________________________ office ____
__________________________ __________________________ __________________________
__________________________ __________________________ __________________________
__________________________ __________________________ __________________________
Do you currently have any other business lines of credit (not business credit cards)? Are they Secured or Unsecured? (If so, please
list bank/lender, balance, and credit limit)
Bank
__________________________
Balance Limit
_________________ _________________
__________________________ _________________ _________________
_________________
How much unsecured business capital are you seeking?
(mark "x" in appropriate field)
(mark "x" in appropriate field)
(mark "x" in appropriate field)
___________________________________________
Gross Annual Sales/Revenues:______________ NET Business Income:__________________
Have you ever filed for Bankruptcy:
Have you ever Been in Foreclosure?
Yes___ No___ If yes, then when?
Yes___ No___ If yes, then when?

2. Credit Check Total Tri-Merge Report: One Dollar ($1) for 7 days. After the free trial, a monthly fee
will be assessed
Credit Verification
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instructions below to successfully create sn account for Credit Check Total, then save your reports to a .PDF
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Click "Print"
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4. *Be advised that any and all information submitted with this Pre-Qualification form is intended solely for
the purpose of establishing the viability of the potential clients’ credit attributes.
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