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About
COVID-19
Events
Programs
Resources
Blog
Let’s Talk!
Capital Consortium Review Form
Name
Phone
Email
What's the best way to reach you?
Phone
Email
No Preference
Are you the:
Business Owner
Property Owner
Both
Business Name
Business Address, City, State, Zip
Mailing address, if different
What is the Business Structure?
Sole Proprietorship
LLC
Corporation
Partnership
Other/TBD
What other business structure do you have?
Number of Full-time Employees
Is there more than one owner?
Yes
No
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?
Crowdfunding
Private Investor
Personal Savings
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
Purchase Equipment
Working Capital
Purchase Inventory
Marketing
Other
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?
Yes
No
Other
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
Yes
No
If you answered "yes" above, what is the approximate value of the collateral that you could pledge?
Which of these does your business have?
Accountant/Bookkeeper
Business Bank Account
Accounting Software
Business Insurance
Other
Do you have any serious credit issues (accounts in collection, money owed to IRS, etc.)?
Yes
No
If you answered "yes" to the above, are you on an approved installment plan?
Yes
No
Have you ever filed for bankruptcy (business or personal)?
Yes
No
If you answered "yes" to the above, is the bankruptcy still active?
Yes
No
Are you currently involved in any lawsuits?
Yes
No
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.
Yes
Please complete the form and click Submit (online) or email the form and any attachments to debi.howe@scorevolunteer.org. 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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