Microloan Application Form - Enterprise Development Corporation

Enterprise Development Corporation

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Microloan Application Form

Date *

Name *

First

Last

Address *

Phone Number *

Email *

Date of Birth *

Race *

Yearly Household Income *

SSN# *

Gender *

Marital Status *

US Citizen *

Yes No

Veteran Status *

Yes No

Disability *

Yes No

Education *

Employment Status *

Business Name *

Business Address *

Business Phone Number *

Date Business Started *

Describe Business *

Federal ID Number *

Business Legal Structure *

Number of Employees - Current *

Number of Employees - Projected *

List all owners and % of ownership *

Working Capital *

Please fill in how much of the total project will be allocated for working capital.

Equipment *

Please fill in how much of the project will be allocated for equipment purchase.

Inventory *

Please fill in how much of the project will be allocated to purchasing inventory.

Other *

Total Project Amount *

This will be the sum of the above categories.

Loan Amount Requested *

This will be the net amount of the total project amount and the cash down payment.

Cash *

Please fill in how much money you have for a down payment.

Assets *

Please fill in the value of the assets that you or the business already own.

Total Funds to Invest *

Total of the cash down payment and assets to contribute to the business.

List Collateral and Value *

Did you contact a bank for financing? *

Yes No

Name of Bank *

Name of Loan Officer *

Brief History of Business *

Describe Products and/or Services *

Describe your experience and qualifications *

List Competitors *

Describe how you will advertise your product/service. *

How did you hear about EDC's microloan program? *

Convicted of Criminal or Civil Offense? *

Yes No

If yes, please explain: *

Lawsuits or Judgements? *

Yes No

If yes, please explain: *

Bankruptcy? *

Yes No

If yes, please explain: *

Previously received Government Financing? *

Yes No

If yes, please explain: *

List 3 references with phone number *