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.)
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Email *
Your name (first, last) & title *
Preferred phone number: *
Name of business or organization *
Date founded *
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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.)
Which of the following best describes the primary purpose(s) of this financing for your business? (Select up to 2) *
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: *
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.)
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?
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