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Owner Name
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First Name
Last Name
Business Name
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Contact Number
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Please enter a valid phone number.
Email Address
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Monthly Revenue
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Please Select
$0 - $10,000
$10,000 - $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000+
Time in Business
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Industry / Business Type
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Please Select
Automotive (Repair, Dealerships, Car Wash, Towing, etc.)
Construction / Contracting
Transportation / Trucking / Logistics
Restaurants / Bars / Food Services
Retail (Clothing, Electronics, Convenience, etc.)
Beauty / Personal Care (Salons, Spas, Barbershops, etc.)
Healthcare (Medical, Dental, Chiropractic, etc.)
Fitness / Gyms / Wellness
Professional Services (Consulting, Marketing, Accounting, etc.)
Real Estate / Property Management
Manufacturing / Wholesale
E-Commerce / Online Business
Technology / IT Services
Hospitality (Hotels, Motels, Travel Services)
Landscaping / Cleaning Services
Education / Childcare
Nonprofit / Religious Organizations
Other (please specify)
Requested Funding Amount
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Purpose of Funding (Optional)
"I consent to have my business information shared with funding partners and contacted regarding funding opportunities."
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