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Business Financing Inquiry Form

Prior to submitting a full application, please complete the following inquiry form to assist your NCIC Business Resource Manager in determining the appropriate financing solution to meet your needs.

Please note that all fields marked * are required.

Part A: CONTACT INFORMATION

Your Name: *
Business Name: *
Business Location
Street: *
City/Town: *
State:
Zip: *
Business Mailing Address (if different than Location)
Street:
City/Town:
State:
Zip:

Best Contact Phone: *	() -
E-mail Address (if none, type N/A):
Website (if none, type N/A):

Part B: DESCRIPTION OF BUSINESS

Type of Business: *

	Sole Proprietor		Partnership
	C Corp		S Corp
	LLC		Non-Profit
	Undetermined

Briefly describe your business

Years you have owned the business: *

Is at least 51% of your business owned by a US Citizen? *

Yes

Years the business has been in existence: *

Number of full time employees
(full time equals 30.5 hours or more/week): *

Number of part time employees
(part time equals less than 30.5 hours/week): *

Do you have a written Business Plan? *

Yes

Last year, what was your gross profit?
(Sales – Cost Of Goods Sold)
(if start up, type N/A): *

Last year, how much did your Business make after all expenses were paid?
(if start up, type N/A): *

Do you have business projections for the next 2 - 3 years? *

Yes

If Yes, did you work with a business advisor? *

Yes

What is the last year for which your business filed tax returns?
(if start up, type N/A): *

Part C: FINANCING NEEDS

How much money do you think your business will need? *
What will the funds be used for? *
Have you applied for financing elsewhere? If so, where? *
Are you willing to personally guaranty this loan if necessary? *
Please describe the collateral available to secure the loan
Equipment/Machinery (if none, type N/A):
Inventory (if none, type N/A):
Furniture & Fixtures (if none, type N/A):
Business Real Estate (if none, type N/A):
Personal Residence (if none, type N/A):
Other Business or Personal Property (if none, type N/A):
Other (if none, type N/A):

Part D: OTHER BUSINESS ASSISTANCE NEEDS

Please check any areas you feel you need assistance with to make your business more successful:

	Accounting		Business Management
	Computer Accounting Systems (i.e. Quickbooks)		Developing a Business Plan
	Hiring Employees		Marketing
	Technology Training		Website Development

Other (please describe):
How did you first hear about NCIC? *

St Johnsbury Office
51 Depot Square, Suite #2
St Johnsbury, VT 05819
T: 802.748.5101 | F: 802.748.1884

Lancaster Office
1 Middle Street
Lancaster, NH 03584
T: 603.788.2700 | F: 603.788.2702

Sign Up for Our Email Newsletter!

Business Financing Inquiry Form

Part A: CONTACT INFORMATION

Business Location

Business Mailing Address (if different than Location)

Part B: DESCRIPTION OF BUSINESS

Briefly describe your business

Part C: FINANCING NEEDS

Please describe the collateral available to secure the loan

Part D: OTHER BUSINESS ASSISTANCE NEEDS