A Lending and Business Consulting Firm
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Charles Barthelemy
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Disaster Assistance
SBA 7A & 504 LOANS
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Free Disaster Assistance Analysis or Call Our Nationwide Hotline: (404) 860-1770
Disaster Assistance Loan Analysis Form
Note:
This is a NO CREDIT CHECK REQUIRED pre-qualification short form. We do not ask for your SSN to pre-qualify. This application is protected and encrypted by a secure server. All of your information is private and confidential.
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If possible, please include their email address or phone number.
Privacy Notice
*Please see our privacy policy at the end of this form.
Your Information
First Name
*
Last Name
*
Business Name*
If Applicable
Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Email Address
*
Daytime Phone
*
Mobile Phone
Your Most Recent Credit Score
*
Excellent 750-850
Very Good 700-749
Good 660-699
Fair 620-659
Poor 580-619
Very Poor 500-579
Don't Know
If you have a recent 3-bureau credit report, you can upload it here. (optional)
This can help us qualify you FASTER! Don't worry about internet security, our servers are secure!
(If you want to create a Credit Check Total account to obtain your 3-bureau credit report without impact to your score go here):
www.creditchecktotal.com
Credit Check Total
If you have a Credit Check Total account and you want us to view it, please send us your login info below.
Username*
Password*
You can change it anytime 🙂 Don't worry about internet security, our servers are secure!
Last 4-digits of SSN
Additional Documents (bank docs, financial statements, etc)
*If applicable.
Additional Documents (bank docs, financial statements, etc)
*If applicable.
Gross Annual Income
*
Loan Amount Requested
Type of Loan Requested
*
SBA Physical Disaster Loan
SBA Economic Injury Loan
Both
Not Sure
Project or Property Type
Please Describe
Have you filed an insurance claim for your damage and/or property losses?
Filing an insurance claim with not disqualify you.
Yes
No
Regarding you or any joint applicant
a) Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction; b) have you been arrested in the past six months for any criminal offense; c) for any criminal offense - other than a minor vehicle violation - have you ever: 1) been convicted, 2) plead guilty, 3) plead nolo contendere, 4) been placed on pretrial diversion, or 5) been placed on any form of parole or probation (including probation before judgement)?
Yes
No
Is the business or a listed owner delinquent on any...
Federal taxes, direct or guaranteed Federal loans (SBA, FHA, VA, student, etc.), Federal contracts, Federal grants, or any child support payments?
Yes
No
Is the applicant or any listed owner currently ...
Suspended or debarred from contracting with the Federal government or receiving Federal grants or loans? .
Yes
No
Privacy Policy
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. The type of service we require has to be shared for the normal course of business. You can opt out of this sharing by not submitting your information. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. What? The types of personal information we collect and share depend on the product or service you have with us. This information can include: • Social Security number and income • Account balances and account transactions • Credit scores and payment history How? All financial companies need to share customers’ personal information to run their everyday business. How does BCC collect my personal information? We collect your personal information when you fill out an application from our company on or offline.To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. Additionally, BCC requires and trains its employees to comply with its privacy standards and policies, which are designed to protect customer information.
Thank you for your application!
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