AfriMatch- Application for Financing

1
Name of Applicant* This field is required.Even if there are more than one applicant - please enter a single point of contact
Prefix
First Name
Middle Name
Last Name
2
E-mail of Applicant* This field is required.This must be a monitored address
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
3
What is your business title?* This field is required.Founder, CEO, President, Director...
4
Business Phone Number of Applicant* This field is required.
Country Code
Area Code
Phone Number
5
Personal Cell Phone * This field is required.(We'll send you text reminders for our upcoming seminar)
Country Code
Area Code
Phone Number
6
Business Address of Applicant* This field is required.If you are a sole proprietor, this can be a home address
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Are you a black owned business? * This field is required.
YESNO
8
Do you own at least 51% of your black owned business?* This field is required.These loans are for people of African descent only. Do not continue this application if you cannot meet this threshold
YESNO
9
Do you already have an African Local Partner?* This field is required.These loans are for people of African descent only. Do not continue this application if you cannot meet this threshold
YESNO
10
Name of African Co-ApplicantEven if there are more than one applicant - please enter a single point of contact
Prefix
First Name
Middle Name
Last Name
11
If you said yes to having an African partner, please describe their role?
Co-Founder
Chief Executive Officer
Chief Operating Officer
Chief Technology Officer
President
Director
12
E-mail of Co-Applicant* This field is required.This must be a monitored address
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
13
What problem does your business address?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
14
What is the solution that your business provides?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
15
What is your target market/customer?* This field is required.
16
Is your organization a nonprofit?* This field is required.We will send you additional information relevant to your nonprofit status
YESNO
17
What is your industry?* This field is required.
Financial Services and Technology
Information Technology and Data
Film, TV, and Media
Education
Clean Energy and Eco-friendly products/services
Food and Beverage
Hotel, Hospitality, and Travel
Entertainment
Healthcare and Medical Technology
Real Estate and Architecture
Agriculture
Retail and E-Commerce
Transportation and Logistics
Nonprofit
Other
18
What does your product provide? * This field is required.
Physical Goods
Software or Hardware
Service
Other
19
Is your business a startup?It's ok, we fund startups all the way to companies that are growing and established
YESNO
20
Where are you in the startup phase?
Pre-seed/ideas
Proof of Concept
Prototype
Minimum Viable Product- developing
Minimum Viable Product- launched
Growth
21
How does your business make money?
Fees/Commissions
Advertisements
Subscriptions
Products or Service Sales
Margins/Spreads
Other
22
How far have your gotten? Please explain
Huge
Large
Normal
Small
Ok
Ok
23
Is your business in operation now?* This field is required.
YESNO
24
Are you looking to grow your business?* This field is required.
YESNO
25
Is your business making money?* This field is required.
YESNO
26
How many founders are on your team?* This field is required.
1-2
3-4
5-6
Other
27
Tell us about your team!
28
How much money are you looking to raise?* This field is required.
29
How much capital have your raised?
30
How will you use this funding?
Huge
Large
Normal
Small
Ok
Ok
31
What is your website address?
32
What is your Twitter handle?
33
What is your Linkedin handle?
34
What is your business Facebook page name?
35
What is your Instagram handle?
36
I agree that the information herein is true and correct
Yes
Should be Empty: