Capital Consortium - Business Information Form

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CAPITAL CONSORTIUM:
BUSINESS INFORMATION FORM
The Capital Consortium is a group of nonprofit lenders, for-profit lenders, and other funders, who work together along
with Philadelphia’s Department of Commerce to improve access to capital for small businesses throughout Philadelphia.
Member organizations provide loans, grants, and technical assistance to small businesses in order to help them start and
grow.
This form helps Capital Consortium members learn about your business and your capital needs. Complete the form
below and email it to
loan.info@phila.gov
or fax it to 215-683-2150 Attention: Capital Consortium. Your information will
be shared with the Consortium members and if your project and capital needs match available resources, members of
the consortium will contact you directly within ten (10) business days.
This form is not a loan or grant application and there is no guarantee of approval from any of the members. If one of the
members is interested in working with you, they will contact you for more information.
APPLICANT INFORMATION
Date: ______________________
Name: _____________________________________________________________ Title: _________________________
Phone #: ____________________ Email Address: ________________________________________________________
What is the best way to reach you?
Phone
Email
Are you the
Business Owner
Property Owner
Both Business and Property Owner
Business Name: ____________________________________________________________________________________
Business Address: _____________________________________________________ ZIP Code: ____________________
Mailing Address
_________________________________________ ZIP Code: ___________________
(if different than above):
Legal Name of Property Owner: _______________________________________________________________________
Commercial Activities License #
___________________________ EIN: ___________________________
(if business owner):
Type of Business: _________________________________________________ Number of Employees: ______________
What is your business structure?
Sole proprietorship
LLC
Corporation
Partnership
Other
Describe your business. What products and services do you offer? How do you market and advertise? What makes
you and your business unique? (If you have a business plan or executive summary, please attach it.)
Created 5/2/2016
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