A micro-equity program for entrepreneurs.
Date of Application

First Name:

Last Name:

Phone Number:

Personal Address:

Business Name:

Business Address:

How many Business Owners are there?

Please list names and contact information for all Owners:

Number of years in business:

Number of years in relevant industry:

What is your vision for the business? What do you plan to achieve?

How do you want your business to help with your personal goals?

What type of ownership is your business?

Have you tried to obtain capital from a bank?

Reason for decline:

How many years have you lived in the community?

Will you be willing to share your financials with us?

What is your monthly gross revenue for your business?

What is your total annual household income?

Are you involved in any organization?

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