Capital Consortium - Business Information Form Page 3
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1
2
3CAPITAL CONSORTIUM:
BUSINESS INFORMATION FORM
Do you have a bank account for your business?
Yes
No
Do you have insurance for your business?
Yes
No
Do you have available collateral that you could pledge on a loan?
Yes
No
I don’t know
If so, list the types and approximate value:
Do you have any serious credit issues, including accounts in collection?
Yes
No
I don’t know
If you have an account in collection, are you on an approved installment plan?
Yes
No
Do you owe the IRS, Commonwealth of Pennsylvania, or City of Philadelphia any back taxes?
Yes
No
If you owe back taxes, are you on an approved repayment plan?
Yes
No
Do you file business tax returns? Individual tax returns?
Individual
Business
Both
Neither
Have you ever filed for bankruptcy (personal and/or business)?
Yes
No
If Yes, is it still active?
Yes
No
Are you involved in any lawsuits?
Yes
No
NEXT STEPS
For more information or to submit your notification of interest, please email
loan.info@phila.gov
or call Jonathan
Snyder at 215-683-2153. Once a completed form is received, it will be forwarded to members of the Capital
Consortium. If they are interested in working with you, they will contact you directly within ten (10) business days.
Created 5/2/2016
Page 3 of 3
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Parent category: Life