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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, itís 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 :

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