Intake form

Help us serve you better

Name *

Email address *

Phone number

Loan amount requested

Purpose of the loan

Preferred loan term

Employment status

Monthly income

Have you applied for a loan before?

How did you hear about us?

Please select at least one option.

Social Media

Friend/Family

Search Engine

Additional questions or comments

Sorry, we were not able to submit the form. Please review the errors and try again.

L&B Capital