Personal Funding Intake Form

Complete all sections below to submit your application.

Personal Information

First Name *

Last Name *

Date of Birth *

Phone *

Email *

SSN *

Address *

City *

State *

ZIP Code *

Employment & Income

Employment Status *

Employer Name

Job Title

Time at Employer

Gross Monthly Income ($) *

Additional Monthly Income ($)

Housing Information

Housing Status *

Monthly Housing Payment ($) *

Time at Residence *

Debt Consolidation

Total Credit Card Debt ($) *

Number of Credit Cards *

Current Monthly Debt Payments ($) *

Primary Goal *

Notes

Document Uploads

Your documents are securely encrypted and kept confidential. They will only be used for processing your application.

Government-Issued Photo ID *

Driver's License or Passport

Click to upload

Proof of Income

Recent pay stubs (last 2) or tax returns

Click to upload

Bank Statements (Last 3 Months)

PDF or images of your bank statements

Click to upload

Consent

I authorize IBJ Capital to review my credit and financial information for the purpose of evaluating my personal funding and debt consolidation options. I certify that the information provided is accurate and complete.

Your information is securely encrypted and kept confidential.