Borrower Inquiry Form - Capital Region Chamber

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First Name*
Last Name*
Business/Company Name*
Phone*
Email*
Is the business located in one of the following counties: Albany, Columbia, Greene, Rensselaer, Saratoga, or Schenectady?*
- Yes
- No
Business entity type (LLC, S-Corp, C-Corp, Sole Proprietor, etc)*
Industry*
Length of time business has been operating*
Loan Request Details
How much funding are you requesting?*
What is the purpose of the loan? (cash flow, working capital, purchase/renovate capital assets, etc.)*
Revenue & Financial Performance
What is your average monthly revenue?*
What is your average monthly expenses?*
Collateral & Guarantees
Are you able to provide collateral?*
- Yes
- No
If yes, what type?
Are you willing to personally guarantee the loan?*
- Yes
- No
Comments
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Loan Request Details