Technical Assistance and Loan Application
Business Introduction Profile
Email address *
Applying For: *
Required
Business Name: *
Business Owner's Name: *
Business Owner's Home Address: *
Email:
Owner's Contact Number *
Business Address *
Web Address:
Business Phone: *
Year Business Started
MM
/
DD
/
YYYY
Type of Business *
Industry:
Product/Services Offered:
Number of Employees
Full Time: *
Part Time: *
Who is Your Primary Customer:
Challenges/Obstacles Facing Your Business: *
Gross Sales Last Full Year: *
Plans for Growth/Expansion Over Next 2 Years:
If Applying For a Loan, How Would You Use the Funds?
Primary Language Spoken: *
Household Size:
Household Gross Income:
Clear selection
Business Owner's Digital Signature *
Rhode Island Black Business Association: (401) 383-1179, RIBBA TA/Loan Application, 3 Regency Plaza, Suite 3E, Providence, RI 02903, SmallBizHelp@RI-BBA.org
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy