General Information

Legal Name of Enterprise

DBA

("doing business as" or assumed/fictitious name, if any) x

Address 1

(headquarters or principal place of business) x

Address 2

City

State

Zip Code

Phone

Website

EIN

(Employer Identification Number or Federal Tax Identification Number) x

Are you a non-profit or for profit entity?

Please select... Non-profit For profit

Entity Type

Please select... C-Corp S-Corp Public Benefit Corporation Cooperative Corporation Limited Liability Company General Partnership Limited Liability Partnership Charter School Private School Other

Entity Type - Other

Jurisdiction

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming Canada(State or other jurisdiction where the entity was incorporated/formed) x

Focus Area 

Climate and EnvironmentEducation and the ArtsFood and AgricultureOther

Focus Area - Other

Industry

Please select... Accounting Services Agriculture Arts Charter School Continuing Education Developmental Disabilities Advocacy Developmental Disabilities Employment Developmental Disabilities Housing Developmental Disability Services Equipment Sales and Manufacturing Fair Trade Food and Beverage Fair Trade - Other Financial Institution Food Hub Green Building and Materials Green Consumer Goods Green Technology Grocery Store Independent Higher Education Independent Primary Education Job Training Journalism Land Management Legal Services Life Sharing Lodging Non-Profit - Other Organic Food and Beverage Personal Care Shipping and Distribution Waldorf Education Waste Management Water Management Other

Industry - Other

Please provide a brief description of your social mission and primary business activity.

Approximately how many  years have you been in operation?

What were your total revenues last year (or alternatively, your total revenues over the last 12 months)?

Please only enter a numerical value (e.g. 1,000.00).

 

  

Primary Contact

First Name

Last Name

Title

Loan Information