Rapid Response Intake Form

Rapid Response Loan Interest Form

Please note: this is NOT an application. Completing this form only expresses interest.
What is your business' legal structure? *
Is your non-profit business a child care provider? *

Yes, we are a child care provider No, we are not a child care provider
Registered Business Address (County) *
Have you earned revenue (made any sales)? *

No Yes
Unfortunately, your business is not eligible to apply for this program for one of the following reasons:

- Your business is not located in one of the 9 qualifying counties: Boone, Johnson, Hamilton, Hancock, Hendricks, Madison, Marion, Morgan, or Shelby County to apply.

- Your business is a non-profit organization

- Your business is a pre-revenue (has not made any sales)
Your Name

First Name Last Name
Your Email *

Confirmation Email example@example.com
Phone Number *
Primary Language *

English Spanish
Name of Business *
Business Registration/Start Date *

Month Day Year
Date
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Business Industry *
Briefly describe the business (services offered, industry, products provided, etc.)? *
How much funding do you need? *
Please enter without the dollar sign
How do you plan to use the funds and do you have any additional comments about how much funding you need? *
Do you have a separate business bank account? *

No Yes
Did you file single and/or personal taxes within the last year? *

Yes No
If you didn't file taxes, why? *
Have you received services from Business Ownership Initiative (BOI) in the past? *

Yes No
How were you referred to the Rapid Response Loans? *
How many employees do you have? *
Are you an Indy Chamber member? *

Yes No No, but I'm interested
XBE Status
Is your business considered women-owned (51% or more of ownership)? *

Yes No
Is your business owned (51% or more) by one of the following races? *

Asian-Indian Asian-Pacific African American or Black Hispanic Native American White or Causasian None of the above
Is your business considered Hispanic or Latinx-owned (51% or more)? *

Yes No
Is your business considered Veteran-owned (51% or more)? *

Yes No
Is your business considered Disability-owned (51% or more)? *

Yes No
Co-Signers Contact Info
The following information will be used on your official Rapid Response Loan application. Your application will require a signature from each owner with 25% or more of the share in the company. Please complete the information below for those owners.

After our staff reviews this completed form, the Owners will receive the official application sent via Hellosign to sign and complete.
How many owners have 25% or more share in the business? *

1 2 3 4
Name: Business Owner #1 *

First Name Last Name
Email: Business Owner #1 *

Confirmation Email example@example.com
Name: Business Owner #2 *

First Name Last Name
Email: Business Owner #2 *

Confirmation Email example@example.com
Name: Business Owner #3 *

First Name Last Name
Email: Business Owner #3 *

Confirmation Email example@example.com
Name: Business Owner #4 *

First Name Last Name
Email: Business Owner #4 *

Confirmation Email example@example.com
Should be Empty:

Rapid Response Loan Interest Form

Co-Signers Contact Info