Loan Assistance Counseling Request

NOTE: Fields marked in RED are required.

Name:
Business Name:
Address:
Phone:
Email:
Are you a current client of the Fort Collins/Larimer SBDC? Yes No
If no, how did you hear about the Fort Collins/Larimer SBDC?
Are you a currently in business? Yes No
If no, when is your intended start date?
Do you have a written business plan? Yes No
Provide a brief description of your company:
On what date was the business established under its current ownership?
Type of Business:	Manufacturing Wholesale Professional Services Service Retail Other:
What is the legal structure of your business?	Sole Proprietorship Partnership Corporation S Corporation LLC
Who are the current owners?
Name: % of Ownership: Name: % of Ownership: Name: % of Ownership:
Current number of employees:
Have you been turned down for a business loan recently? Yes No
If yes, by whom?
What is the purpose of the loan request?	Startup Expansion Business Purchase Real Estate Equipment Other:
How much money will you be requesting?
How much do you plan on investing in the project?
Can you furnish:
Financial Projections (startup only):	Yes No
Balance Sheet (no more than 45 days old):	Yes No
Profit and Loss Statement (no more than 45 days old):	Yes No
Past 3 Years Business Tax Returns:	Yes No
How would you rate your personal credit?	Excellent Good Fair Poor
Are you willing to personally gurantee the loan?	Yes No