PLEASE PRINT OR TYPE & PLEASE READ AND
ANSWER EVERY QUESTION










CHOOSE ONE















Do you need Credit Repair (Choose Yes OR No):


CHOOSE YES OR NO

Do you have a physical office?

Do you have a current web site?

Do you have a business email?

Have you filed your business taxes for the last 2 years?

What is your gross monthly Income for your company?

Do you have your breakdown of what you will be needed funds for in detail?

Do you currently have Business Credit Score Pay dex with dun and Brad Street?

Do you currently have a Business Bank account?

Amount of Funding You are Seeking?

What is your goal with the funds you are seeking?

Notes: A Rep from Patriot Choice will be contacting you with in 48-72 hours to give you a Free Interview.