Do you have a business checking account? (Yes/No)*

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Amount of Funding Requested ($)

What Will The Funding Be Used For?*

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Time in Business or Gig Work *

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Approx. Monthly Business or Gig-Work Revenue ($)*

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How soon do you need funding? (Immediately / Within 2 weeks / Within 30–90 days / Just exploring)*

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Approximate Personal Credit Score or Range

Have you applied for business financing in the past 30 days? (Yes/No)*

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Do you currently have business financing? If yes, approximately how much is still owed?

Name*

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Business Name*

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E-mail*

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Phone Number*

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Explore Your Funding Options

Telephone: 508-492-5592

E-mail: funding@luippoldcapital.com

Address: 867 Boylston Street, 5th Floor, #1010
Boston, MA 02116