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Capital Consortium Review Form
What's the best way to reach you?
Are you the:
Business Address, City, State, Zip
Mailing address, if different
What is the Business Structure?
What other business structure do you have?
Number of Full-time Employees
Is there more than one owner?
If there is another owner, please list all of their name(s) and percentage of ownership like this: (Owner 1: Tom Thumb, 22%). Do this for all owners.
Describe your business. What products and services do you offer? What makes your business unique?
If you have a business plan or executive summary please upload it here. If you are submitting via PDF/email, include a copy of the plan(s) as an attachment to that email submission.
How much funding are you seeking?
How is your business funded?
Personal Credit Card
Other bank loan
If you have a funding source not listed above, please describe it here.
What will funds be used for?
Renovate/Fit Out Interior
Renovate/Fit Out Exterior
If you have a plan to use funds for something else, please describe it here.
Describe the improvements, equipment or projects that this financing will be used for:
Is your business a startup?
How many years has your business been open?
What is your average annual revenue (past 3 year average)?
How much existing debt do you have (personal and business)?
Do you have collateral that you could pledge on a loan
If you answered "yes" above, what is the approximate value of the collateral that you could pledge?
Which of these does your business have?
Business Bank Account
Do you have any serious credit issues (accounts in collection, money owed to IRS, etc.)?
If you answered "yes" to the above, are you on an approved installment plan?
Have you ever filed for bankruptcy (business or personal)?
If you answered "yes" to the above, is the bankruptcy still active?
Are you currently involved in any lawsuits?
How did you hear about the Capital Consortium?
Is there any other relevant information about this request that you wish to share?
Consent: By completing and submitting this form, I give permission for the information that I have provided to be shared among members of the Capital Consortium.
Please complete the form and click Submit (online) or email the form and any attachments to email@example.com. If you have any questions, please contact SCORE at (269) 344-1419. Once a completed form is received, it will be forwarded to the members of the Capital Consortium for review. If they are interested in moving forward with your project, you will be contacted within 10 business days.
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Learn more about GKBR
For info call the SCORE Kalamazoo/SW Michigan Office at
email Debi Howe