New Client Inquiry - Northwest Oregon - Region #1

Name*

First Last

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Please tell us a little about your business...

Are you a start-up or an existing business?*

Start-Up
Existing Business

How many years has this business operated?

What industry/sector is the business part of?*

What type of business is it?*

Number of full-time employees?*

Number of part-time employees?*

How much capital are you looking for?*

Reason for capital?*

How much cash do you have available to invest in this business?*

Have you been denied access to capital by a lender?*

Yes
No

What is your timeline for your capital needs?*

Using a 5-star rating, how would you rate your credit score?*

1 star
2 stars
3 stars
4 stars
5 stars

(1 = less than good) (5 = excellent)

Please share your current level of readiness to seek financing and work with the Capital Access Team:

I have an updated business plan.*

Yes
No
Not Applicable

I have 24 months of month-by-month financial projections.*

Yes
No
Not Applicable

I have 3 years of personal tax returns.*

Yes
No
Not Applicable

I have 3 years of business tax returns (for this existing business).*

Yes
No
Not Applicable

I have completed an updated Personal Financial Statement.*

Yes
No
Not Applicable

I have my credit report available to review.*

Yes
No
Not Applicable

Are you currently working with your local Small Business Development Center (SBDC) on getting funded?*

Yes
No

How did you learn about the OSBDCN's Capital Access Team?*

Referral from my SBDC advisor
Referral from my banker
Personal research
Referral from economic development professional
Referral from another client

If you received a referral to the Capital Access Team, please share specifically who referred you and from where.

Example: (Jeff Jacobs - SBDC Advisor - Lane Community College SBDC - Eugene)

Name

This field is for validation purposes and should be left unchanged.

New Client Inquiry – Northwest Oregon – Region #1

CAT New Client Inquiry – Northwest Oregon – Region #1

Please tell us a little about your business...

Please share your current level of readiness to seek financing and work with the Capital Access Team: