Salesforce Form

First Name*

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Last Name*

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Phone:

Email*

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Name of Business*

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Type of Business*

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Age of Business*
We define startups as businesses with less than 2 years of cash flow. Our startup funding is typically focused on the childcare industry.

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Please describe your business in a few sentences*

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Address of Business:

Desired Loan Amount*
Commercial loans start at $15,000. For loans under $15,000, contact your nearest branch.

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Use of Loan Proceeds*
Please describe how you will use the loan proceeds. For example, buying property, construction, operations, equipment, etc.

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Project Location*
Loans below $500,000 are limited to North Carolina and Illinois.

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Anticipated Equity Contribution*
How much of your own money do you plan to put toward this project? This amount can also include any money already spent toward this project.

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Do you have collateral to secure the loan?*
Please describe the collateral you hope to use, and its estimated value. Self-Help prefers real estate as collateral, like a personal home, business building, etc. Other types of collateral may include vehicles and equipment.

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Who referred you to us?*

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What is the name of your referral’s organization?*

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