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Business Funding Intake Form

SECTION 1 — Contact Information

Full Name

Phone Number

Email Address

City and State


Section 2 — Business Information

Business Name

Business Industry

Business Structure

Business Structure

Business Start Date

Section 3 — Funding Request

How much funding are you seeking?

What will the funding be used for?

Section 4 — Business Activity

Do you currently have a business bank account?

Do you currently have a business bank account?

How long has your business been operating?

Do you have at least 3 months of business bank statements?

Do you have at least 3 months of business bank statements?

Section 5 — Transportation Companies

Is your business related to transportation or trucking?

Is your business related to transportation or trucking?

Section 6 — Agreement

Section 6 — Agreement