CBG Funds — Client Intake Form

* Required fields

Client Type

Personal Information

First Name *

Last Name *

Email *

Phone *

Date of Birth

State

Address

Social Security Number

Leave blank if you have an ITIN instead

ITIN Number (If no SSN)

ITIN begins with 9 — issued by IRS Form W-7. Leave blank if you have an SSN.

Credit Profile

Estimated Credit Score

680

300I don't know my score850

Housing Status

Employment Status

Annual Income

Funding Goal

Business Information (required for Business or Both)

Business Name

Entity Type

Time in Business

Monthly Revenue

Anything else we should know?

How did you hear about us?

By submitting this form you consent to being contacted by our team regarding your funding options. All information is kept strictly confidential and used only for the purpose of determining your eligibility. This is not a credit application and does not affect your credit score.

✅

Application Received!

Thank you — our team will review your information and reach out within 24–48 hours to discuss your funding options.

Please check your email for a confirmation.

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