RAP: Commercial Real Estate—Insurance & Financing Registration Form
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
Phone Number
*
E-mail
*
example@example.com
Gender
*
Please Select
Male
Female
Other
Decline to identify
Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Decline to identify
Ethnicity
*
Please Select
Caucasian/White
African American/Black
Hispanic/Latino
Asian
Native American
Other
Decline to identify
Current Business Status
*
Please Select
Start Up (2 years or less)
Pre-Venture (more than 3 years)
Established (5 years)
Do you currently lease or own the space in which your business operates?
Lease
Own
N/A
Do you currently have insurance on your business?
Yes
No
Do you currently have insurance on your business property (leased or owned)?
Yes
No
NA
Are you interested in obtaining capital for your business?
Yes
No
How did you hear about this opportunity?
Word of Mouth
TruFund Employee
Social Media
Other
Done
Should be Empty: