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Unity Lender Financial Questionnaire
Step
1
of
10
10%
Credit Check Consent
(Required)
The purpose of this questionnaire is to determine your eligibility for a loan from Unity Lender LLC. The information within this form is necessary to evaluate your financial eligibility. Unity Lender LLC requires a credit check to evaluation and approve any loans. By checking the box below, you are expressly authorizing Unity Lender LLC to run a credit check. Please check one:
I consent to a credit check by Unity Lender LLC as part of my application for a loan.
I do not consent to a credit check by Unity Lender LLC as this time, but understand it is required for Unity Lender to finalize and approve any loan agreement.
Desired Loan Amount
(Required)
50,000
60,000
70,000
80,000
90,000
100,000
110,000
120,000
130,000
140,000
150,000
160,000
170,000
180,000
190,000
200,000
210,000
220,000
230,000
240,000
250,000
260,000
270,000
280,000
290,000
300,000
Desired Loan Length (In Months)
(Required)
12
18
24
30
36
42
48
54
60
APPLICANT INFORMATION
Please provide the following information regarding the Loan Applicant. Please answer N/A for any fields which are not applicable to you.
First Name
(Required)
Last Name
(Required)
Current Country of Residence
(Required)
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country of Origin
(Required)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Passport Number
(Required)
Street Address
(Required)
Address Line 2
City
(Required)
State
(Required)
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
If live outside of United States, choose CA and enter your state / province / region in next box.
Province / Region
ZIP / Postal Code
(Required)
Country
(Required)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Phone Number
(Required)
Email
(Required)
Date of Birth
(Required)
YYYY dash MM dash DD
Gender
(Required)
Male
Female
This is required by our loan software.
CO-SIGNER OR GUARANTOR (OPTIONAL)
Please provide the information for the Co-Signer and/or Guarantor for your loan. The Unity Lender team will also subsequently require additional financial information of the Co-Signer or Guarantor to close on the loan.
Will you be adding a co-signer or guarantor to your loan application?
(Required)
No
Yes, I will have a co-signer or guarantor
What is your relationship to the Co-signer or Guarantor?
(Required)
Spouse
Parent
Child
Sibling
Other Family Member
Friend
Other
Other (Please Specify)
(Required)
First Name
(Required)
Last Name
(Required)
Street Address
(Required)
Address Line 2
City
(Required)
State
(Required)
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
If live outside of United States, choose CA and enter your state / province / region in next box.
Province / Region
ZIP / Postal Code
(Required)
Country
(Required)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Email Address
(Required)
Phone Number
(Required)
BUSINESS OR EMPLOYMENT INFORMATION
Please provide the following information regarding your Business or Employment. Please answer N/A for any fields which are not applicable to you.
Occupation
(Required)
Job Title
(Required)
Employment Status
(Required)
Full Time
Part Time
Unemployed
Current Employer
(Required)
Years of Employment with Current Employer
(Required)
Are you self-employed?
(Required)
No
Yes
If Self Employed, Name of Business
(Required)
Street Address
(Required)
Address Line 2
City
(Required)
State
(Required)
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
If business is located outside of United States, choose CA and enter your state / province / region in next box.
Province / Region
ZIP / Postal Code
(Required)
Country
(Required)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Business - Phone Number
(Required)
Business - Email
(Required)
INVESTOR ELIGIBILITY QUESTIONNAIRE
Unity Lender requires all customers to be accredited investors as defined in Rule 501 of Regulation D. To invest in many alternative investment classes such as hedge funds, venture capital, or private equity, an individual must qualify as an accredited investor. Customers of Unity Lender LLC will be required to provide a letter evidencing Accredited Investor status from a Certified Public Accountant, Attorney or appropriately licensed professional before final approval of any Unity Lender LLC Loans. You only need to meet one of the status requirements below to qualify as an accredited investor.
Accredited Investor Status - Net Worth
(Required)
I am an “accredited investor” as defined in Rule 501 of Regulation D under the Act because I have a net worth (or joint net worth with my spouse) in excess of US$1,000,000. For purposes of this question, “net worth” means the excess of total assets (excluding value of primary residence) over total liabilities. (Please Note: The estimated fair market value of the primary residence is not included as an asset and the amount of debt secured by the primary residence, up to the estimated fair market value of the property, is not included as a liability. However, the amount of any debt secured by the primary residence that is in excess of the estimated fair market value of the primary residence is included as a liability. In addition, if the amount of debt secured by the primary residence increased within the last 60 days (other than as a result of acquiring the residence), then the amount of the increase is included as a liability.)
Yes
No
Accredited Investor Status - Net Income
(Required)
I am an “accredited investor” as defined in Rule 501 of Regulation D under the Act because I have had individual income in excess of US$200,000 (excluding my spouse) in each of the two most recent years (or joint income with my spouse in excess of US$300,000 in each of those years) and have a reasonable expectation of reaching the same income level in the current year.
Yes
No
Accredited Investor Status - Professional Certifications
(Required)
I am an “accredited investor” as defined in Rule 501 of Regulation D under the Act because I hold one or more valid professional certifications, designations, or other credentials, which are active and that have been designated by the SEC, including the Series 7, Series 82, and Series 65 licenses, and any additional qualifying professional certifications, designations and credentials that may be designated by the SEC from time to time.
Yes
No
FINANCIAL BACKGROUND
Please answer the following questions fully to provide an accurate and complete picture of your present financial position. You must consent to a credit check as well as provide tax returns and other financial documentation in order to be approved for a Unity Lender loan. Please provide annualized numbers.
FICO Credit Score
(Required)
CREDIT SCORE INFORMATION: Please provide your approximate FICO credit score from a free credit report provider (e.g., Credit Wise, Credit Karma, FreeCreditReport.com.
INCOME
Please provide the following information regarding your Income. Please answer N/A for any fields which are not applicable to you.
Annual Salary & Bonus
(Required)
Next Year Expected Salary & Bonus
(Required)
Annual Interest & Dividend Income
(Required)
Monthly Rental Income
(Required)
Annual Other Business Income (Please Specify)
(Required)
Annual Other Income (Please Specify)
(Required)
EXPENSE
Please provide the following information regarding your Expenses. Please answer N/A for any fields which are not applicable to you.
Total Monthly Rent or Mortgage
(Required)
Annual Property Taxes
(Required)
Annual State Income Taxes Paid
(Required)
Annual Federal Income Taxes Paid
(Required)
Monthly Debt Payments (Please Specify)
(Required)
Monthly Other Large Payments (Please Specify)
(Required)
CO-SIGNER FINANCIALS
Please provide the following information regarding your financial information of the Co-Signer and/or Guarantor. Please answer N/A for any fields which are not applicable to you.
Annual Salary & Bonus
(Required)
Next Year Expected Salary & Bonus
(Required)
Annual Interest & Dividend Income
(Required)
Monthly Rental Income
(Required)
Other Business Income (Please Specify)
(Required)
Other Income (Please Specify)
(Required)
Total Monthly Rent or Mortgage
(Required)
Annual Property Taxes
(Required)
Annual State Income Taxes Paid
(Required)
Annual Federal Income Taxes Paid
(Required)
Monthly Debt Payments (Please Specify)
(Required)
Monthly Other Large Payments (Please Specify)
(Required)
ASSETS
Please provide the following information regarding your Assets. Please answer N/A for any fields which are not applicable to you.
Approximate Value of Real Estate Owned (Include Purchase Date)
(Required)
Please Include Gross Value, Liabilities on Assets (e.g., Home Mortgage), Purchase Dates, and Relevant Notes for each Real Estate Asset You Own
Checking & Savings Account
(Required)
Please Include Gross Value and Relevant Notes for each Checking or Savings Account You Own
Brokerage Accounts (Stocks, Bonds, 401k, etc.)
(Required)
Please Include Gross Value, Liabilities on Assets, and Relevant Notes for each Brokerage Account You Own
Crypto Currencies
(Required)
Please Include Gross Value, Liabilities on Assets, and Relevant Notes for the Sum Total of Crypto Currency You Own
Business Ownership (Approximate Value of Interest)
(Required)
Please Include Gross Value, Liabilities on Assets, and Relevant Notes for each Business You Own
Other Assets (Please Specify)
(Required)
Please Include Gross Value, Liabilities on Assets, and Relevant Notes for each Other Asset You Own
LIABILITIES
Please provide the following information regarding your Liabilities . Please answer N/A for any fields which are not applicable to you.
Revolving Debt (e.g., Credit Cards)
(Required)
Please Include Total Debt Outstanding and Relevant Notes
Home Loans and HELOCs
(Required)
Please Include Total Debt Outstanding and Relevant Notes
Business Loans
(Required)
Please Include Total Debt Outstanding and Relevant Notes
Car Loans
(Required)
Please Include Total Debt Outstanding and Relevant Notes
Student Loan Debt
(Required)
Please Include Total Debt Outstanding and Relevant Notes
Other Household Debt (Please Specify)
(Required)
Please Include Total Debt Outstanding and Relevant Notes
CREDIT HISTORY
Please answer the following questions. If you answer yes to any of the questions, please provide additional details.
1) Are there any outstanding judgments against you?
(Required)
Yes
No
1) If yes, please explain:
2) Have you declared bankruptcy within the past 7 years?
(Required)
Yes
No
2) If yes, please explain:
3) Have you had property foreclosed upon or given title or deed in lieu thereof in the past 7 years?
(Required)
Yes
No
3) If yes, please explain:
4) Are you a party to a lawsuit?
(Required)
Yes
No
4) If yes, please explain:
5) Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
(Required)
Yes
No
5) If yes, please explain:
6) Are presently delinquent or in default on any debt, loan, mortgage, financial obligation, bond, or loan guarantee?
(Required)
Yes
No
6) If yes, please explain:
7) Are you obligated to pay alimony, child support, or separate maintenance?
(Required)
Yes
No
7) If yes, please explain:
8) Are you a co-maker or endorser on a note?
(Required)
Yes
No
8) If yes, please explain:
9) Do you intend to take out a loan, line of credit or other form of indebtedness, whether as direct borrower, co-signer, or guarantor in the next 90 days?
(Required)
Yes
No
9) If yes, please explain:
IMMIGRATION ATTORNEY
Please provide relevant information on your immigration attorney.
Have you hired an immigration attorney?
(Required)
Yes
No
Attorney Name?
(Required)
KLD LLP
Other
Other Attorney (Please Specify)
(Required)
BEHRING EB- 5 INFORMATION
Please specify who you are working with at Behring to pursue your EB-5 investment.
Behring Team Member
(Required)
Christina Ji
Christyn Karol
Colin Behring
Gao Bei
Greg Sheehan
Kyle Behring
Matt Parolie
Peter Bibler
Not Listed
Other Behring Team Member
(Required)
Please type the name of the Behring team member if not on previous list.
EB-5 Investment Project
(Required)
BRC Partners V LP (1900 Bway)
BRC Legacy Partners LP (1900 Bway)
BRC Partners VII LP (RISE)
BRC Legacy Partners LP (RISE)
IMPORTANT: The EB-5 Investment Project can be modified subsequently if you have not made a final decision yet.
UNDERSTANDING
I certify that the answers given herein and during the entire application process (including but not limited to information provided in attachments to this application, interviews or otherwise (if applicable)) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers during the application process may disqualify me from further consideration for a loan.
(Required)
Yes, I Certify and Understand
Full Legal Name
(Required)
Date
(Required)
YYYY dash MM dash DD
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