Business Loans Inquiry Form for Additional Owners

First Name *

Last Name *

Date of Birth *

Applicants must be at least 18 years of age

Phone *

Enter 10 digits only (numbers only, no dashes or spaces)

Email *

Housing Status *

Self-Reported Annual Income (Before Taxes) *

Include earned wages before taxes are taken out, self-employment income after business expenses, unemployment benefits, Social Security, and other regular income received by members of your household. Please include income from all household members. This information may be verified if you apply.

Do you identify as a person with a disability? *

Gender *

Used only to determine eligibility for certain grant-funded programs.

Ethnicity *

Used only to determine eligibility for certain grant-funded programs.

Race - Please select all that apply: *

Used only to determine eligibility for certain grant-funded programs.

Veteran Status *

Citizenship Status *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Number of People in Your Household *

Generally, a household consists of anyone related to you by birth or marriage living in the same residence.

What percentage of the business do you own or expect to own? *

Enter 0 if you are a guarantor only.

How much experience do you have in your business' industry? *

List your management or ownership experience: *

Business Owner Name(s) *

I certify that the information provided in this eligibility form is true, complete, and correct to the best of my knowledge and belief. *

I certify and agree to the statement above.

Typed Name (Electronic Signature) *

By typing my name above, I acknowledge this as my electronic signature.