Loan Intake Form

* Email

Business Website

* Business Phone

* Your Mobile Phone

Later on, we will verify your identity by texting a code to this phone number when you log in. Numbers with hyphens please, such as 607-272-1234.

* Business Name

* First Name

* Last Name

* Street

* City

* County

* State

* ZIP

My business address is the same as my home address.YesNo

Are you or your business a member ofAlternatives Federal Credit UnionCooperative FederalNeither

* Business Start Date

* Tell us about the business. What is your product or service?

* Is your business NYS Certified?Woman ownedMinority ownedBothNeither

* How much are you looking to borrow?

* What is the purpose of your loan?

* Can you provide a cash flow statement for two years?YesNo

* Can you provide a written business plan?YesNo

Providing a response to these questions will help us to identify if you may be eligible for special loan programs.

Owner Gender

Owner EthnicityHispanicNot HispanicNo response

Is this owner a veteran?YesNoNo Response

Does this owner have a disability?YesNoNo Response

How did you hear about Business Loan Connection?