Business Finance Interest Form

Company

Salutation
–None–Mr.Ms.Mrs.Dr.Prof.Hon.

First Name

Last Name

City

State/Province

Country

Phone

Email

Is the business 51% or more?
–None–Minority OwnedVeteran OwnedWomen OwnedMBE

NAICS Industry
–None–Agriculture, Forestry, Fishing and HuntingMining, Quarrying, and Oil and Gas ExtractionUtilitiesConstructionManufacturingWholesale TradeRetail TradeTransportation and WarehousingInformationFinance and InsuranceReal Estate and Rental and LeasingProfessional, Scientific, and Technical ServicesManagement of Companies and EnterprisesAdministrative and Support and Waste Management and Remediation ServicesEducational ServicesHealth Care and Social AssistanceArts, Entertainment, and RecreationAccommodation and Food ServicesOther Services (except Public Administration)Public Administration

Is business registered in State of MD?
–None–YesNo

What county is the business located in?

What type of loan are you applying for?
–None–LIFT Micro-Loan ($10,000 – $30,000)Catalyst Fund ($30,001 – $500,000)FLEX Line of Credit ($30,000 – $100,000)

Requested Loan Amount?

How did you hear about us?