Legal Business Name *

Trade Name/DEA (If different than legal name) *

Industry *

Entity Type *

Tax ID (Federal EIN) *

D-U-N-S # 0 of 9 max characters. Numeric characters only.

Business Start Date * Please indicate date of incorporation, if applicable.

# of Employees * Please enter a number greater than or equal to 1.

Street Address

Address Line 2

City

State

Phone *

Email *

How much money are you seeking?

What percent of the business do you own?

What is your average monthly revenue over the last 3 months? $0 $1–4K $5k–7k $8K–14k $15K–19k $20K–49k $50K–79k $80K+

What are your annual profits? <$24K $24K+ $48K+ $72K+ $96K+ $120K+ $180K+ $240K+

How's your personal credit score? 720 or above 680 – 719 650 – 679 600 – 649 500 – 599 499 or below

What's your annual personal income? Below $30K $30K - $50K $50K - $75K $75K - $100K $100K - $150K Above $150K

Upload Credit Report Upload multiple files as zip. Only Zip files allowed.

Select all that apply

Accept credit cards

Have a prior bankruptcy

Operate as a franchise

Invoice customers

Operate as a non-profit

Do business seasonally

Have accounts receivables

Have a 401K over $50K

Please list any sources of business credit or funding the business currently has or has recently applied for in the past 180 days (investor or bank)

Best Day and Time Best date and time to speak with your business adviser (M-F, 9-4 pm Pacific)?