Equitable Small Business Initiative Intake Form
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Email *
Please enter your first and last name. *
Please enter your company name. *
Please enter your work phone number. *
Please enter your address. *
Please enter your city, state and zip code. *
What type of loan are you applying for? *
How is your business structured? *
Where did you hear about the Equitable Small Business Initiative (ESBI)?
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What is your business type?
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What is your main company trade or Service? *
How many years have you been in business? *
Personal Credit Score range *
What County is your business located in? *
Technical Assistance is provided with all lending options: Please check all areas that apply to your company's growth and sustainability. *
The following information is not required and will not be used to process this application, but it does help us describe our borrowers to the investors who enable New Jersey Community Capital's ability to provide loan products *
Are you certified with the state as a certified Small (SBE), Minority (MBE), Woman (WBE), Service Disabled Veteran (SDVBE), Disadvantage (DBE) Black Business Enterprise (BBE)? *
Specify below which state(s) you are certified (Enter N/A if not applicable) *
Did you receive or apply for a PPP Loan? *
Please note any additional comments related to PPP below:
2019 Gross Revenue *
2020 Gross Revenue *
2021 Gross Revenue *
2022 Projected Gross Revenue *
Start ups only* Please identify your start up phase below.
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How many employees do you have Full-Time (FT) and Part-Time (PT)? *
How many personal credit cards do you have? *
How many business credit cards do you have? *
Professional Credit Limit? *
Personal Credit Limit? *
Loan amount you are requesting? *
Please explain your planned use of the funds requested. *
During the pandemic did you implement work from home operations? *
Due to the pandemic did you cut hours of operations? *
Are you a member of the AACCNJ ? *
How has the Covid-19 Pandemic affected your business? *
Do you use a payroll system? *
Do you plan on hiring more people? *
Do you volunteer in the community? *
Do you offer Medical Benefits? *
Do you offer Dental Benefits? *
Do you offer a 401k or other retirement plan? *
Do you offer sick time pay? *
If approved for any of our loan products, you will have the opportunity to receive FREE Technical Assistance Service and One on One Coaching Services. Please check all areas below that apply to your needs. *
Continued Supportive Service Options *
Please enter any additional comments pertaining to continue supportive service below.
Below is a list of required financial documents that will be requested for your loan application. Please check all documentation that you will be able to submit upon request. If you file your personal tax return with schedules for your business please include all schedules filed with your Federal Tax return.  If you file a separate business tax return we will need the business return as well. Anything unique toyour business please note in the comment box. *
Please note anything unique to your business pertaining to the items above:
Has the business or a listed owner been involved in a bankruptcy or insolvency proceeding within the last 24 months? *
Does the business or a listed owner have any outstanding judgements, tax liens, or lawsuits againstthem? *
Is the business or listed owner delinquent on federal taxes, loans, contracts, grants, or child support payments? *
If there is anything else you would like us to know or service you may need that was not listed above, please share.
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