Referral Information

Before we get started, please tell us how did you heard about us? *

Please provide the name of the person who referred you:

Contact Information

Full Name *

Best email address *

Mobile Number *

I agree to receive communications from Geared4Growth and Encore Business Development which may include SMS messages, emails, and calls regarding my inquiry, funding options, and relevant updates. I understand that message and data rates may apply for SMS, and I can opt-out at any time by replying STOP to an SMS or clicking unsubscribe in an email.

I understand this is an initial intake form for evaluation and strategy purposes only, not a formal loan application. If my project looks like a fit, I understand we may need additional information and standard SBA or lender forms to move forward with an actual approval. I confirm the information I am submitting is accurate and complete to the best of my knowledge. I am an authorized representative of the business named above and have the authority to submit this application.

Business Information

Do you currently own a business? *

How long have you been in business?

Business Legal Name

Is there a DBA Name? If so, please enter it here.

Entity Type

Street Address

City

State

Country

Postal Code

Industry

Please provide a brief description of your business:

What type of business do you seek funding for? *

Which range best describes your average monthly sales/revenue?

Is your business currently profitable (after paying yourself something)?

Credit & Income

Which best describes your personal credit band? (Estimate only — we do NOT pull credit from this form.) *

Do you have any bankruptcies in your history? *

What was the approximate discharge date or the year you filed?

Annual personal income? *

Please enter your annual household income. (If married)

Project & Funding Goal

How much capital are you seeking? *

What are you primarily looking to fund right now? (Select all that apply) *

Please provide a description of the project you want us to look at: *

What is your best guess of the total amount you think you’ll need for this project (all-in)? (Building, buildout, equipment, and working capital if needed.) *

Readiness & Prior Funding Experience

How soon are you hoping to have funding in place? *

Have you ever applied for an SBA loan before? *

What year was your last SBA loan funded?

What was the outcome or reason for denial?

What’s your biggest question or concern about funding your project right now? *

Anything else you think we need to know?

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