Name of Business

Contact's Email

Loan Amount Requested?

What is the capital for?

If other, please explain

What is the age of the company?

What was the Gross Revenue for the previous fiscal year?

What was the Net Revenue for the previous fiscal year?

How many full years of accountant prepared financial statements are completed?

If Other...explain

Any new contracts or pending contracts, new purchase orders or new customers who will increase revenue by more than 20% next year?

Does the shareholder(s) have good credit history?

Do you have a comprehensive business plan?

NOTES

COMPANY STORY