Académique Documents
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LOANQUESTIONNAIRE
QUESTIONNAIRE
LOAN
Your name: _______________________
NO [ ]
_________________________________________________________________
Who are your customers? __________________________________________________________________
_________________________________________________________________
Are you profitable? _______________________________________________________________________
_________________________________________________________________
What excites you about your business right now? _______________________________________________
_________________________________________________________________
What keeps you awake at night?_____________________________________________________________
_________________________________________________________________
What barriers do you see that could get in the way of your business success? ________________________
______________________________________________________________________________________
Where do you sell your product or services and who is your competition? ___________________________
_______________________________________________________________________________________
If NO, give us your background. What experience do you have that would make this proposed business
successful? ______________________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
What is your current monthly income? ____________________ Describe how that will be changing as a result
of this business venture. _____________________________________________________________________
_________________________________________________________________________________________
Please provide documentation for all sources of current income (paystubs, tax returns, bank statements, etc.)
Are you in business by yourself? YES [ ] NO [ ]
Do you have a partner? YES [ ]
_________________________________________________________________________________________
Have you filed business tax returns? YES [ ]
If yes, please provide the most recent copy of your business and/or personal filed tax returns.
Please provide any documents that show your business is growing or has the potential to grow. For example,
what is your marketing plan? Do you have bank statements that show your cash flow? If so, please provide
copies and attach any additional information that will help us make this loan decision.
Monthly PMT
Account #
Term
2. If you have not established a traditional credit history, please provide alternative documentation to show
your payment history for monthly obligations such as rent, telephone, electricity, etc.
3. Please give us the names and phone numbers of people who would vouch for your credit worthiness
(minimum of two references).
Name of Reference
Telephone Number
Relationship
Telephone Number
Relationship
D. General:
5.
Telephone Number
6.
7.
Account #
Amt of Coverage
Telephone Number
8.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
E. Is there other information you feel is important for us to know about your business or background? Please
attach any documents that may help us evaluate your loan request.
__________________________________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
F. How did you find out about us? _____________________________________________________________
___________________________________________________________________
G. Please sign the statement below to give us permission to contact your creditors:
Date: __________________________
In connection with my loan application to the Next Step Loan Fund I/(we) hereby authorize The Opportunity
Alliance to verify and collect credit information including, but not limited to, bank references and trade and
credit references.
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Signature(s)/Title(s): _______________________________________________
____________________________
Printed Name(s):
_______________________________________________
____________________________
Name of Business:
_______________________________________________
Submit Application
Revised: 9/26/2013
Print Application
Application Checklist
Completed Application: [ ]
Completed Signature Page: [ ]
Electronic attachments or hard copies of requested financial documents: [ ]
Once you have completed your application, you can submit electronically, or mail a hard copy.
When you push the 'submit application' button, your email program will open, allowing you to
attach electronic copies of the requested financial documents to the email before sending.
If you are mailing your application, use the 'print' button to print out your application; make
sure to sign the signature page and include photocopies of the requested financial documents
with your application.
Mailing address:
The Opportunity Alliance
Next Step Loan Committee
50 Monument Square, 6th Fl
Portland ME 04101
If you have any questions, email: info@opportunityalliance.org, or call Christine Stelling, SVP of
Development and Communications: 523-5030