Business and Grant Funding Program – Financial Solutions & Business Management

First and Last Name:*

Address:*

City:*

State:*

Postal Code:*

Email address*

Referred by:*

Phone:*

Birthdate:*

Name of Business:*

Business Address:*

Business Phone Number:*

Business Email:*

How long you been in Business?*

Date Business was established?*

How many Employees do you have?*

Business Structure?*

LLC

Sole Proprietorship

S Corporation

C Corporation

How much does your business gross currently?

What was your expenses? What did it cost you to operate your business? (Including payroll, rent/mortgage and utilities.)*

Which Industry does your business fall under? (Finance, Hospitality, Construction, Daycare etc.)*

(Landlords Only) How many rental properties do you have?*

I understand that I will receive an e-sign contract once enrolled in the Business and Grant Funding Program.*

I agree

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