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Retirement Biz Funding

Borrower Preliminary Information Form
Business Name (*)

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Individual Name (*)

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Email (*)

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Best Number. We will only call if you opt to work with a TA and pay the TA fee of $295

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Title (*)

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US Citizen? (*)

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If not US, Type of Visa or Alien Registration

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1) Are you presently under indictment, on parole or probation? (*)

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2) Have you ever been charged with or arrested for any criminal offense other than a minor vehicle violation (including offenses which have been dismissed, discharged, or nolle prosequi)? (*)

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3) Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation including adjudication withheld pending probation for any criminal offense other than a minor vehicle violation? (*)

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4) Has an application for the loan you are applying for now ever been submitted to SBA under any program? (*)

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5) Are you presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency? (*)

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6) If you are at least a 50% or more owner of applicant business, are you more than 60 days delinquent on any obligation to pay child support arising under an administrative order, court order, repayment agreement between the holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support enforcement services? (*)

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I will be using the free SBA Express Loan Assessment Tool (*)

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NOTE: If you selected "yes" to the FREE tool, your application will not be processed through us. You will have to go to the SBA and find an SBA loan provider that DOES NOT charge the TA fee of $295.

I will be using SBA Technical Assistance provided by CFT. I understand that I will be sent a URL to make the payment of $295 BEFORE the TA calls me back to start the work.

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If you answered yes to any of questions 1 through 6 above, an application may not be submitted under SBAExpress procedures except according to the SBAExpress Program Guide, § 5.A.(5)(d).



Owner information is necessary to complete your SBA application. If you do not complete this secti0n, we cannot process your SBA loan request

Home Phone (*)

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Cell Phone (*)

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Home Address (no PO Boxes) (*)

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City (*)

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State and Zip Code (*)

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Social Security Number (*)

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Select the option that best fits your situation (*)



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Years at Current Address (*)

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Business Ownership Percentage (*)

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Date of Birth MM/DD/YYYY (*)

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Drivers License Number (*)

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Drivers License State (*)

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Your Personal Annual Income (*)

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Other Income

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Sources of Other Income

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Enter Security Code

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Agreement (*)

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