Name

 *

Name

Business Name

 *

Business Name

Telephone Number

 *

Telephone Numberext.

Email Address

 *

Email Address

---

QUESTIONS

Please answer the questions below to help determine if your business qualifies for this loan strategy.

1. What date was your business started?

 *

1. What date was your business started?

2. What is the legal structure of your business?

2. What is the legal structure of your business?

Sole Proprietorship

C-Corporation

S-Corporation

Partnership

Limited Liability Company (LLC)

Non-Profit

3. Have you completed the proper filings to establish your business with the North Carolina Secretary of State’s office or the Pitt County Register of Deeds office?

3. Have you completed the proper filings to establish your business with the North Carolina Secretary of State’s office or the Pitt County Register of Deeds office?

Yes

No

4. Based on your most recently filed annual federal tax return, what were the gross receipts of your business?

 *

4. Based on your most recently filed annual federal tax return, what were the gross receipts of your business?

5. What is your home address?

 *

5. What is your home address?

6. What is your business address?

 *

6. What is your business address?

7. Have you applied for a loan from another lender?

7. Have you applied for a loan from another lender?

Yes

No

What was the result of your application?

What was the result of your application?

8.  Are you a citizen to the United States?

8. Are you a citizen to the United States?

Yes

No

9. If you are a new business, have you completed the MWBE Business Skills Boot Camp or were you referred by the SBTDC or other counseling agencies?

 *

9. If you are a new business, have you completed the MWBE Business Skills Boot Camp or were you referred by the SBTDC or other counseling agencies?

10. Have you completed a business plan for your business?

10. Have you completed a business plan for your business?

Yes

No

11. Do you have any delinquent local, state or federal taxes?

11. Do you have any delinquent local, state or federal taxes?

Yes

No

12. Describe your business including a brief history and the products and/or service(s) your business provides?

 *

12. Describe your business including a brief history and the products and/or service(s) your business provides?

13. Explain why you want to participate in this loan program and how it will help your business grow.

 *

13. Explain why you want to participate in this loan program and how it will help your business grow.

You will be contacted to let you know how to proceed.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

To prevent spam we utilize a verification code system. Please enter the code as it is shown in the box below:

 

Code:

Page 1 / 1