Business Funding Interest Form

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Business Funding Interest Form

All information must be accurate and submitted in full.

SECTION 1. CONTACT INFORMATION

First Name*

Last Name*

Business Name

Primary Email*

Primary Phone*

SECTION 2. BUSINESS INFORMATION

Industry

Time In Business

SECTION 3. BUSINESS SETUP

Do you have an EIN?

Yes

No

Do you have a business bank account?

Yes

No

Do you currently have business credit?

Yes

No

SECTION 4. REVENUE INFORMATION

Current Monthly Revenue:

Under $5,000

$5,000-$10,000

$10,000-$25,000

$25,000-$50,000

$50,000+

SECTION 5. FUNDING REQUEST

How much funding are you seeking?

Under $10,000

$10,000-$25,000

$25,000-$50,000

$50,000-$100,000

$100,000+

Purpose Of Funds (Select all that apply)

Startup Costs

Equipment

Inventory

Marketing

Payroll

Expansion

Working Capital

Real Estate

Debt Consolidation

Other

SECTION 6. FUNDING HISTORY

Have you ever been denied business funding?

Yes

No

Have you received business funding before?

Yes

No

SECTION 7. FUNDING GOALS

Tell us about your funding goals.

Additional Notes