Loan Intake Form

Below please find a few data points that will be used to determine the initial direction for us to consider in helping supply the insurance agency loan on your business. We will follow this information up with a written response and a conference call if warranted.

(*) - Required field

First and Last Name

Your Company Name

Company Address

Phone Number

*E-Mail Address

Website Address

Your estimated revenue (annual commission and fees)

Corporate structure type

Type of insurance product(s) sold

List of company owners and corresponding percentage ownership share

Estimated Credit Score

Have you ever had a personal bankruptcy?

Have you ever had a tax lien?

Insurance agency loan amount requested

Will tax returns, P&L's and balance sheets be available for both buyer and seller?

Have you already applied for an insurance agency loan for this project? With whom?

Please provide a short written overview of the project including how the loan proceeds will be utilized, if it is a company purchase, size of revenue (commission) and expected purchase price.

In need of insurance premium financing? Our purpose is to provide superior insurance premium financing services for the property and casualty agent. Insurance premium financing can earn income for agents and maximize cash flow for companies. Premium Finance Associates offers the best premium finance options to agents.

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The Springtree Group is a company of entrepreneurs helping entrepreneurs. We offer a full spectrum of Mergers & Acquisition, lending and financial performance services and products to the Insurance Community.

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