Preliminary application for funding:

Company name:

Address:

Phone:

Fax:

Web address:

Contact person:

Email:

Description of business/products/services:

SIC code:

Located in a
low-income* or rural area:

No
Yes

* A census tract with a median income below 80 percent of the median for the entire metropolitan area/state.

Management team:

Principal competitors (3-5):

Board of directors/advisors:

Name of legal counsel:

Name of accountants/auditors:

Five (5) largest customers (incl. % each):

Amount of funding being sought:

Use of proceeds:

Business history/projections

Is there a
business plan available?

No
Yes