LDC New Client Questionnaire

Please fill out the form below. Fields marked with * are required

What is the Name of Your Business?*

What amount are you seeking to finance?

Your Name:*

Your Email:*

Website Address:

Telephone Number:*

Fax Number:

Business Address:

Address 2:

City:

County:

Zip:

Briefly describe your business:
Briefly describe why you are seeking financing:
Briefly describe how you will use the funds:
Briefly describe what collateral you will use:

To start your appication, do you have the following?

A complete business plan:

A summary of the amount of the loan that is being requested and the uses of proceeds:

A current personal financial statements for each business owner:

Federal Tax Returns for three years for each business owner:

Proof of US Citizenship or Lawful Permanent Residency for each business owner:

Proof of each majority business owner’s residency in the LDC’s lending area:

Have you applied for business credit with another lender?:

Was the application with another lender approved?:

Have you received mentoring from SCORE, SBDC, WBC or other organization?: