Capital Navigation Intake Form
Please complete the inquiry form below with as much detail as possible. Once submitted, a member of our team will be in touch to explore financing options with you.
About You
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What are your pronouns?
She, Her, Hers
He, Him, His
They, Them, Theirs
My pronouns are not listed above.
With which gender do you most identify?
Male
Female
Nonbinary
Prefer not to say
My gender is not listed above
With which ethnic/racial group(s) do you most identify?
Asian
Black or African American
Hispanic or Latino/a/x
Indigenous Peoples
First Nations
Native American, or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White or Caucasian
Prefer not to say
My ethnic/racial group is not listed above
About your Business
The following questions will help us identify options that may fit your business so we can be prepared for our meeting.
Business Name
*
Business Website
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide a brief description of your business
*
Legal Structure
*
Sole Proprietorship
S Corporation
C Corporation
Partnership
Have you participated in any of SEG's programs?
*
Ideator
Incubator
Incubadora
Accelerator
Other SEG Program
No
What is your business' operating budget?
*
$0 to $9,999
$10,000 to $49,999
$50,000 - $99,999
$100,000 to $249,999
$250,000 to $499,999
$500,000 to $999,999
$1,000,000 to $4,999,999
$5,000,000 to $9,999,999
$10,000,000+
I do not want to answer at this time
Business Credit Score
*
What are your capital needs?
What type of capital are you seeking? (Select all that apply)
*
Debt (e.g., loans, lines of credit)
Equity (e.g., investment in exchange for ownership)
Hybrid (e.g., convertible notes, revenue-based financing)
Unsure / Need Guidance
Amount
*
Please describe your capital needs:
*
Submit
Should be Empty: