Borrower inquiry form
Please complete this brief form to provide us some information about your business or organization. A member of our borrower services team will contact you once we have received your responses. (This is not a loan application form, and there is no fee associated with the submission of this inquiry form.)
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Your name (first, last) & title
*
Your answer
Preferred phone number:
*
Your answer
Name of business or organization
*
Your answer
Date founded
*
MM
/
DD
/
YYYY
EIN/Tax ID #
*
Your answer
Website
Please include https:// or http:// (feel free to include a social media link if no website is available)
Your answer
Which of the following best describes your business' or organization's primary industry sector?
*
Choose
Administrative and business support services
Agriculture and support services
Arts, entertainment, and recreation
Construction, contracting, and utilities
Educational services
Food, beverage, and hospitality
Health care
Manufacturing
Technical, scientific and professional services
Publishing and information services
Religious, grantmaking, civic, professional or similar services
Real estate, housing, rental and leasing
Retail sales and trade
Social assistance and services
Transportation and warehousing
Merchant and wholesade trade
Briefly describe your business' or organization's primary activities and mission:
*
How would you describe what your business does in basic terms? What goods or services do you provide? Do you have a mission statement?
Your answer
Briefly describe the primary location(s) where your business or organization operates and the population(s) served:
*
Where are the key geographies where you work? What are the specific states, cities, ZIP codes, or neighborhoods? Who are the primary individuals and communities in these areas?
Your answer
What is the amount of financing you are interested in from Mission Driven Finance?
*
Your best educated guess here is helpful. (This isn't final information; it's enough to get us started and you will have an opportunity to update this figure on the loan application.)
Less than $50,000
$50,000–$100,000
$100,001–$250,000
$250,001–$500,000
More than $500,000
Other:
Which of the following best describes the primary purpose(s) of this financing for your business? (Select up to 2)
*
Business acquisition
Business expansion (brick and mortar)
Capital equipment or machinery
Inventory or other materials
Leasehold or tenant improvements
Real estate acquisition or refinance
Real estate pre-development or development, including construction
Refinance existing debt
Marketing, legal, or other professional services
Working capital or cash flow
Other:
Required
Briefly describe what impact objectives you expect this capital to help your business achieve:
*
Describe briefly how this capital would position your business to better support your community. Whose lives might be improved? (Think your employees, local students, families in your community, immigrant entrepreneurs in your area.) How do you expect this capital will meaningfully generate, increase, or accelerate your business' mission and impact outcomes?
Your answer
What was your business' or organization's total revenue for the prior fiscal year?
*
If actual figures are not available, your best educated guess here is helpful. (This isn't final information; it's enough to get us started and you will have an opportunity to update this figure on the loan application.)
Your answer
What is your business' or organization's expected total revenue for the current fiscal year?
*
Your best educated guess here is helpful. (This isn't final information; it's enough to get us started and you will have an opportunity to update this figure on the loan application.)
Your answer
What is your business' or organization's projected total revenue for the next fiscal year?
*
Your best educated guess here is helpful. (This isn't final information; it's enough to get us started and you will have an opportunity to update this figure on the loan application.)
Your answer
Does your business or organization currently have any outstanding debt or other long-term liabilities? If so, please provide the total amount and a brief description:
*
If actual figures are not available, your best educated guess here is helpful. (This isn't final information; it's enough to get us started and you will have an opportunity to update this figure on the loan application.)
Your answer
How did you hear about us?
Whom may we thank for referring you to Mission Driven Finance?
Your answer
Additional comments
Is there anything else you would like to share with our team at this time?
Your answer
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mission Driven Finance.
Report Abuse
Forms
