Borrower inquiry form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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.)

Email *

Your name (first, last) & title *

Preferred phone number: *

Name of business or organization *

Date founded *

YYYY

EIN/Tax ID # *

Website

Please include https:// or http:// (feel free to include a social media link if no website is available)

Which of the following best describes your business' or organization's primary industry sector? *

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?

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?

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?

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.)

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.)

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.)

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: *

How did you hear about us?

Whom may we thank for referring you to Mission Driven Finance?

Additional comments

Is there anything else you would like to share with our team at this time?

Clear form

Never submit passwords through Google Forms.

This form was created inside of Mission Driven Finance. Report Abuse

Forms