Pre-Screen Application 1Borrower Information2Loan Information3Optional Information Borrower InformationBy filling out this form, you are agreeing to be contacted by a Diamond Financial Services relationship manager. First Name: Last Name: Email address: Phone #:Best way to contact you:Phone / MorningPhone / AfternoonEmail / MorningEmail / AfternoonLocation: City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Do you currently have ownership in other businesses?YesNoWere you referred to Diamond Financial?YesNoReferral name: Loan InformationThe following questions are about the use of loan proceeds and other information.What will the loan proceeds be used for?Business acquisitionStart-upRefinancingBusiness name: Industry: Business location: City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Proposed ownership structure post-acquisition:Loan use description:Loan amount: How much can you put towards a down payment? Is real estate involved?YesNoReal estate amount: Optional InformationThe following questions are optional, but can be very useful to evaluate whether you will qualify for an SBA loan. Please take a few minutes to fill out what you can.Have you applied for a loan recently?YesNoWith which bank and why? Do you have any unpaid taxes?YesNoDo you have a payment plan agreed to with the IRS?YesNoDo you have any student loans outstanding?YesNoAre you current with your payments?YesNoDo you own real estate?YesYes - Multiple PropertiesNoWhat is your estimated equity position in your real estate? Do you have own any other potential collateral?Are you a United States citizen?YesNoAre you a permanent resident?YesNoCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
