Funding request with Iceberg

Name

First name

Phone number

Email

Survey (Note: If you answered "yes" to any of the following questions, you will not be approved for this program)

1. Is your gross annual income over $21,000?
YesNo

2. Have you filed 2 or more claims with a bankruptcy trustee?
YesNo

3. Do you owe $1500 or more in judgements/prosecutions/collections?
YesNo

4. Have you had 2 or more accounts written off as losses by a Collection Agency?
YesNo

5. Do you have a temporary Social Insurance Number (beginning with 9)?
YesNo

An agent will contact you shortly to verify your eligibility.