Loan Pre-Qualification Survey
Required Required Question(s)
Required 1.
LOAN PRE-QUALIFICATION ASSESSMENT Please help us serve you better by taking a few moments to fill out this survey form. This survey will give us a preliminary assessment of where you financially stand in the loan application process. All financial information can be completed using estimates and will be kept confidential.
First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.
Description of Business
 

  • 350 characters left.
3.

% of Ownership (Who owns what)
 

  • 50 characters left.
4.
Start-up Date
 

  • 50 characters left.
5.
Type of Legal Entity
Sole Proprietor
LLC
Partnership
Corporation
6.

Loan Amount Requested
 

  • 50 characters left.
7.
Purpose of Loan
Working Capital
Inventory
Equipment
Vehicle
Other real estate
Other  
8.

Specifically, how will you be spending the loan (please provide a list of how much you expect to spend on what from the loan (Ex: $25,000 truck, $2000 signage, $3000 working capital, etc)
 

  • 1000 characters left.
9.
Do you own any assets that can be pledged as collateral? (Only assets that you own outright can be considered as collateral.)
Yes
No
10.
If you answered 'Yes' on question 8, then please indicate:
Business Assets
Home
Vehicles
Other real estate
11.

If you answered "Yes" what is the value of each?
 

  • 350 characters left.
12.
What is your total monthly income from all household sources?
 

  • 50 characters left.
13.

What are your total personal monthly expenses?
 

  • 50 characters left.
14.
What are the average gross monthly sales of your business?
 

  • 50 characters left.
15.
What are the average gross monthly expenses of your business?
 

  • 50 characters left.
16.

What is the estimated value of your personal assets? Please indicate: a. Cash, Checking & Savings: b. Real Estate (Market Value): c. Life insurance (Cash surrender value): d. Bonds, Stocks, etc.: e. Automobile (Market Value): f. Credit card balance: g. Other assets:
(List each with dollar amount)
 

  • 350 characters left.
17.

What are estimated personal liabilities? Please indicate the amounts below. a. Total credit card balance: b. Total bank loan balance: c. Total auto loan balance d. Total mortgage balance: e. Total student loan balance: f. Credit card balance: g. Other liabilities:
(List each with dollar amount)
 

  • 50 characters left.
18.
Have you and/or the business ever filed bankruptcy? Please comment if you select 'Yes'.
Yes
No
  • Comment:

  • 500 characters left.
19.
Do you have any collection items or unpaid taxes? If Yes, please explain in comment box.
Yes
No
  • Comment:

  • 500 characters left.
20.
Do you have any pending police, public, or legal issues? If Yes, please explain in comment box.
Yes
No
  • Comment:

  • 500 characters left.
21.
Are you or your business involved in any lawsuits? If Yes, please explain in comment box.
Yes
No
  • Comment:

  • 500 characters left.
22.
Do you owe any outstanding child support?
Yes
No
23.
Have you ever defaulted on a federal government contract or student loan?
Yes
No
24.

What proof do you have of owner equity (i.e. cash to invest/receipts of business purchases)?
 

  • 50 characters left.
25.
Do you have a completed written business plan with 2 years of cash projections?
Yes
No
26.
Are you a US citizen, or do you have a green card or other proof of residence?
Yes
No
27.
Have you had 3 or more months of sales or do you have contracts for future sales?
Yes
No
28.
Do you or someone in your household have a secondary source of income?
Yes
No
29.

If so, how much per month?
 

  • 50 characters left.
30.

How much of a profit or loss did your business have last year?
 

  • 50 characters left.
31.

List your formal training/experience in your field of business.
 

  • 350 characters left.
32.
Have you had any personal or business bank accounts with checks returned due to non-sufficient funds?
Yes
No
33.

If you answered "Yes" what were the circumstances?
 

  • 350 characters left.
34.
Do you own real estate? (Excluding your residence)
Yes
No
35.

If you answered "Yes" please describe property, balance owed, etc.
 

  • 350 characters left.
36.
Are you currently paying off a vehicle purchase or lease?
Yes
No
37.

If you answered "Yes" to who, how much per month and what is the last payment due date?
 

  • 350 characters left.
38.
Is there another person who is willing to guarantee your loan?
Yes
No
39.

If you answered "Yes" who and what is their relationship to you?
 

  • 50 characters left.
40.
Will a credit report show that you have been current with creditors over the past 2 years?
Yes
No
41.

If not, why not? Please explain.
 

  • 350 characters left.
42.
Have you addressed any derogatory statements on your credit report?
Yes
No
43.

If so/not please explain.
 

  • 350 characters left.
44.

Please give us a brief but concise summary of your business: what you do for who, how long.......
 

  • 1000 characters left.

Thank you for taking time to fill out this survey. Your survey will now be reviewed for clarity before being submitted to the lenders.  We will notify you of completion or changes you may have to make. 

If you need to contact us with questions or additional information, email us at sbdc@tcnj.edu or check out our website: www.sbdcnj.com