Please complete all sections of the form to qualify a lead. Thank you! LEAD SOURCE Source * Please specify the source of the lead. LOAN PRE-QUALIFICATION How much? * $ Use of funds * How fast? * Started date * Authenticated T.I.B. MM DD YYYY Monthly gross income * Averange $ Anual gross income * It must reflect the gross income reported on their corporate tax returns. $ BUSINESS INFORMATION Does the client’s business currently have any loans? * Select an option Yes No If that's the case, please provide details about the current loans. Business name * EIN * Industry * Business bank name * Business Adress * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Phone * (###) ### #### Business Email * Website * Business Credit * OWNER (S) INFORMATION Name * First Name Last Name Date of Birth * MM DD YYYY Onwership % * Credit Score * ID Number * Phone * (###) ### #### Email * Owner - 2nd / if ther is any Name - 2nd First Name Last Name Date of Birth - 2nd MM DD YYYY Ownership - 2nd Credit socre - 2nd Id Number - 2nd Phone - 2nd (###) ### #### Email - 2nd NOTES * WCS * Who was responsible for qualifying the lead? Andres Jose Luis Pati Thank you!
