Application Form – Genesis Funding

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Application Form

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Contact Information
Prequalification Questions
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Company Name

First Name

Last Name

Phone/Mobile

Email

Address

City

State

Zip Code

1.How much money are you looking for and what are your plans for its use?

2.Do you own 100% of the business?

3.Are you depositing into that account monthly? how much?

4.How long has the business been operating?

5.Do you have any tax liens or bankruptcies?

6.Have you ever done a short-term business loan? Do you have a balance?

Application Additional Notes