INSTANT PREQUALIFICATION. Complete form to see if you qualify. Qualify Form Name*TitleEmail* Company*PhoneIs the company a fully reporting company currently listed on a US stock exchange?*YesNoWhat is the ticker symbol of the company?*How much working capital is the company looking for?What is the company’s current market cap?Below $1 million$1-$5 million$5-$50 millionOver $50 millionDoes the company have existing convertible debt that it may have an interest in refinancing?*NoYes, under $100,000Yes, $100,000-$500,000Yes, over $500,000Comments This iframe contains the logic required to handle Ajax powered Gravity Forms.