Wufoo
USA1 Properties Prequalification Form
Name
*
First
Last
Home Address
*
City
*
State
*
--Select A State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Phone Number
*
###
-
###
-
####
Check All That Apply
*
Home
Cell
Work
Email Address
*
About Your Business
Legal Business Name
*
Type of Business (I.E Automotive, restaurant, investment)
*
Type of Entity: (I.E. S-Corp, LLC)
*
When Did You Incorporate?
*
MM
/
DD
/
YYYY
Do you currently have any business credit cards? (If so, please list bank/lender balance and credit limit)
Bank/Lender
Balance
Limit
Do you currently have any other business lines of credit (not business credit cards)? Are they
S
ecured or
U
nsecured? (If so, please list bank/lender, balance, and credit limit)
Type of Line
S
U
Bank/Lender
Balance
Limit
S
U
S
U
Do you have a 9-digit D-U-N-S Number?
Yes
No
D-U-N-S#
*
Do you know your Business Paydex Score?
Yes
No
Paydex Score
*
How much unsecured business capital are you seeking?
*
$50k
$75k
$100k
$150k
$200k
Other Amount
Have you ever filed for Bankruptcy?
*
No
Yes
When did you file for Bankruptcy?
*
MM
/
DD
/
YYYY
Have you ever been in Foreclosure?
*
No
Yes
When were you in Foreclosure?
*
MM
/
DD
/
YYYY
Are there Judgements, Collections or Liens on your Credit Report?
*
No
Yes
Comments:
Enter any extra information that may be helpful in reviewing your prequalification
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Click the submit button below to complete the prequalification process. A representative will get back to you within one business day. Thank you.
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