Borrower inquiry form
Please complete this brief form to provide us some information about your business. A member of our borrower services team will contact you once we have received your responses.
Email address *
Your name (first, last) & title *
Business name *
Business website *
Please include https:// or http://
Preferred phone number: *
Preferred email address: *
Briefly describe your business' primary activities and mission: *
What is a boilerplate description of what you do? What goods or services do you provide? Do you have a mission statement?
Briefly describe the primary location(s) where your business 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? *
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: *
If this capital gap is closed, what opportunity gaps could then be closed? How you expect this capital will meaningfully generate, increase, or accelerate your business' mission and impact outcomes?
What was your business' total revenue for the prior fiscal year? *
What is your business' expected total revenue for the current fiscal year? *
What is your business' projected total revenue for the next fiscal year? *
Does your business 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?
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