Sba Form 413 - Personal Financial Statement, Lisc Small Business Pre-Screen Form
ADVERTISEMENT
1
2
3
4
5LISC SMALL BUSINESS PRE-SCREEN FORM
Thank you for your interest in applying for a small business loan through the Local Initiatives Support Corporation (LISC). This
intake form allows us to prescreen your loan request; additional information will be required after an initial review. If filling
out the form electronically, please save to your computer first to ensure your information is not lost. If you have any
questions, please contact Mary Los Klasen, Vice President of Business Lending, at
or (708) 610-8011.
Company Information
Business Name:
Phone Number:
Nature of Business:
Year Business Started:
Franchise?
Tax ID Number:
Address:
City:
State:
Zip Code:
Website Address:
Email Address:
Individual Information
Name:
Phone Number:
Home Address:
City:
State:
Zip Code:
Place of Birth:
Date of Birth:
Social Security Number:
Email Address:
Are you a veteran? ☐ YES ☐ NO
If so, please provide service dates:
Branch of military service:
Were you discharged honorably? ☐ YES ☐ NO
What is your estimated credit score?
Are you a citizen of the United States? ☐ YES ☐ NO
Business Ownership Structure
Percentage of
Owner Name
Position
Ownership (must
total 100%)
1.
2.
3.
4.
SBA Eligibility Questions
If you answer “yes” to any of the following questions, please attach additional written explanation.
1. Do you have any affiliated companies?
☐ YES ☐ NO
2. Have you or any other principals of your company been involved in any bankruptcy or insolvency proceedings?
☐ YES ☐ NO
3. Are you or any other principals of your company involved in any pending lawsuits?
☐ YES ☐ NO
4. Are any of your personal or business tax obligations past due?
☐ YES ☐ NO
5. Have you been arrested in the past six months for any criminal offense?
☐ YES ☐ NO
1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business