Working Capital

Eligibility Review Application
For Small Businesses

In order to help us evaluate the feasibility of helping you in your funding requirements, please complete and submit this form.
IMPORTANT: The only tool we have in analyzing our ability to fill your needs is the information you supply us. It is therefore very important that this preliminary information is accurate and complete.

Applicant Information

Name

Email Address

Phone Number

Fax Number

Organization

Best Time To Contact

Postal Address

Type of Business:

Date Established:

Start-Up:

Type of Entity:
Sole-Proprietorship | Partnership | Corporation

Number of Employees:

After Funding:

Initial Capitalization of the Business (select one):

Source:

A brief description of the business, it’s product and/or services, and the market you are targeting or will target:

A brief summary of your business background, experience, or education in this field:

Request and Use of Loan Proceeds

Land Acquisition:

Inventory purchase:

Building expansion or repair:

New plant or building construction:

Working Capital (including accounts payable):

Acquisition of all or part of existing business:

Acquisition and/or repair of machinery/equipment:

Pay off bank loans:

Other debt payment:

All other uses of proceeds (specify):

Amount:

Total Loan Request:

Total Amount of Self-Investment Funds (if any):

Percentage Guarantee Request (100%, 90%, etc.):
%

Comments :

Working Capital

Eligibility Review ApplicationFor Small Businesses

Eligibility Review Application
For Small Businesses