Request Information for Loan - The Brooklyn Economic Development Corporation

Brooklyn Economic Development Corporation

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REQUEST INFORMATION FOR LOAN

Owners Personal Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Telephone:
Fax:
Email:
Website:
Gender:Female:
Male:
Company Information
Company Name:
Contact Person:
Title::
Company Address:
City:
State:
Zip:
Phone#1:
Phone#2:
Fax:
Email:
Business Description:
Tell us about your business:
Demographic:
Is the business more than 50% woman-owned?
Yes:
No:
Is the business more than 50% minority-owned?
Yes:
No:
If yes, Asian:
African American:
Hispanic:
Native American:
Others:
Sector:
Manufacturing:
Retail:
Wholesale:
Service:
Construction:
Transportation:
Technology:
Non-Profit:
Experience:
Owner's industry experience: years
Owner's management experience: years
Stage of Business:
Start-up:
Operating:	Year Founded:
Revenues:Last Fiscal Year $
Financial Information:
Amount Requested:	$
Purpose:(What will you use the money for?)

Does owner have a a Business Plan (w/financial projections)?
Yes:
No:
Owner's cash invested or committed $
Does owner report a positive credit history?
Yes:
No:
If no, has there been repair activity?
Yes:
No:
Explain:
Have you received any other funding?
Yes:	How much: $
	Name of funding source:
No:
Does owner have collateral?
Yes:
No:
If yes; Cash:
Business Assets:
Co-signer:
Home:
Other Financial Assets:
Referral Source: ( How did you hear about BEDC?)
Source Name:
Source Type:
Loan Fund:
Bank:
SBDC:
BOC:
Website:
Other:

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