Business Debt Consolidation Application

Minimum Qualification: $30,000 in Business Debt
This is NOT a new loan. We negotiate principal reductions, extended terms, and structured settlements — directly with your lenders on your behalf.

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Principal / Owner Information

Contact details of the business owner or authorized representative

First Name *

Last Name *

Title / Role *

Ownership % *

Email Address *

Mobile Phone *

Best Time to Contact

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Business Information

Legal entity details and operating address

Legal Business Name *

DBA (if different)

EIN / Tax ID

Business Street Address *

City *

State *

ZIP Code *

Business Type / Entity *

Industry *

Years in Business *

Number of Employees

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Loan / Debt Details

List each business debt (minimum total $30,000 to qualify)

Types of Debt Included *

Individual Lender Breakdown *

Add one row per lender. Account status = current (payments made) or default/collections. Both are eligible.

Lender / Creditor Name	Debt Type	Current Balance ($)	Account Status

Estimated Total Debt: $0

Business Financial Snapshot

Monthly Gross Revenue *

Monthly Business Expenses

Net Monthly Cash Flow *

Positive = surplus · Negative = shortfall

Total Monthly Debt Payments

Current Overall Payment Status *

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Business Hardship Statement

This narrative supports your case during lender negotiations

Primary Reason(s) for Financial Hardship *

Describe Your Hardship in Detail *

Have You Previously Attempted to Restructure or Settle These Debts?

Referral & Additional Notes

Referred By

Referring Person's Name

Is There a Current Legal Action Against the Business?

Additional Comments / Notes

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Application Submitted!

Thank you for trusting us with your business. An attorney-backed advisor will review your full application and contact you within 2 hours with your debt relief options.

You'll receive a confirmation email shortly at the address you provided.