The Funding Boutique Preliminary Questionnaire

Welcome to The Funding Boutique!

Tell us about your vision!

Preliminary Questionnaire

The Funding Boutique works with a variety of lending programs for:

Technology
Maker to Market
Small Business
Entertainment
Entrepreneurs

Commercial
Startups
Sustainable Tech
Real Estate
Veterans

Please provide the following information to assist with prequalification for funding.

Contact Zenobia should you have any questions: Zenobia@TheFundingBoutique.com • 626.340.4077

Date*

MonthDayYear
Date
1. BASIC COMPANY INFORMATION
Name of Company:*
Contact Person:*
Position:*
Contact Email:*
example@example.com
Contact Phone Number:*

Area CodePhone Number
Phone Number:

Area CodePhone Number
Main Business Location:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*

Area CodePhone Number
Business Email
example@example.com
Product or service description (one sentence)*
Website:
Industry:*
Years in Industry:*
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2. COMPANY DATA
Company type*

Sole ProprietorLLCS CorpC CorpSPCOther
Date Registered:

MonthDayYear
Date
Years in business*
Founder and/or owner:*
Company officers and positions (including founder or owner):*
3. FUNDING PROFILE
Funding project description (very brief):*
Amount desired:*
Minimum funds desired:*
Use of funds (summary list and amounts [total = ask desired]):*
Type of funding desired (debt / equity / both / best available):*
Term rate/points expectation (maximum)
Company revenues:*
Personal credit state*

poorfairgoodexcellent
FICO scores (Experian and Transunion and Equifax):*
DTI (Debt to Income) %:
Skeletons in the closet - What do I need to know?*
Additional pertinent information
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