APPLICATION FORM Personal InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Gender(Required)MaleFemaleOtherPrefer not to sayRace(Required) Highest Level of Formal Education(Required)High school diploma/GEDSome collegeAssociate's degreeCompleted degree - not business relatedCompleted business degreeProfessional licenseBusiness Information and ExperienceBusiness Legal Name(Required) Business Website Business Email(Required) Business Phone Number(Required)Business Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code If you have attended business training, please list up to three. Please indicate whether they were online or in person.Years of Business Experience1234567891010+What is a primary reason you started the business? Experience in the industry Loved the products Need a more flexible schedule Opportunity to make more money Needed income Other Other What is another primary reason you started the business? Experience in the industry Loved the products Need a more flexible schedule Opportunity to make more money Needed income Other Other Form of BusinessSole ProprietorshipPartnershipS-CorpC-CorpLLCNot registered with the Secretary of StateBusiness Start Date MM slash DD slash YYYY What are your business goals for the next two years?Product or Service InformationProduct or Service Target Market IndustryAccommodation and Food ServiceAgricultureBusiness ServicesConstructionDentists/PhysiciansEducational ServicesFinance and InsuranceGas Station and Convenience StoresHealthcare and Social AssistanceHotelsInformation TechnologyLandlordManufacturingMiningProfessional ServicesReal EstateRestaurantRetailTransportation and WarehousingUtilitiesWaste ManagementWholesale TradeOtherAssets and RevenueAnnual Gross Revenue: Current Yearless than $50k$50k - $100k$100k - $250k$250k - $500k$500k - $1M$1M - $2M$2M - $5M+Annual Gross Revenue: Previous Yearless than $50k$50k - $100k$100k - $250k$250k - $500k$500k - $1M$1M - $2M$2M - $5M+Profit: Current YearLost more than $50kLost $50k - $25kLost $25k - $0Made less than $5kMade $5k - $10kMade $10k - $25kMade $25k - $50k+Profit: Previous YearLost more than $50kLost $50k - $25kLost $25k - $0Made less than $5kMade $5k - $10kMade $10k - $25kMade $25k - $50k+Paid Staff: How many full time employees? Paid Staff: How many part time employees? Paid Staff: How many contractors? Do you have a building(s), equipment, and other assets? Yes No If you own assets, what is the collateral? Check all that apply. Building(s) Equipment Inventory Cash Other Lending InterestsAre you interested in obtaining a loan? Yes No If yes, what amount would you like to borrow?Less than $25k$25k - $50k$50k - $100k$100k - $200k$200k+How will you use the loan proceeds? Check any that apply. Building(s) Equipment Inventory Cash Other Accounting and MarketingWho does your accounting?YouAn EmployeeBookkeeperCPAFamily MemberHow frequently do you review cash flow, income, and/or balance sheet statements?MonthlyQuarterlyAnnuallyRandomlyNeverWho handles your marketing?YouAn EmployeeFamily MemberMarketing FirmThird PartyDo your sales and marketing efforts include any of the following? Check all that apply. Website Twitter Other Social Media Flyers Facebook Instagram Magazine TV Ads LinkedIn TikTok Print Ads Radio Ads Post Custom Field
