MICROLOAN PROGRAM – LOAN INQUIRY FORM

Please complete the following form to help us determine your eligibility for our loan program & provide you with appropriate recommendations and referrals to help you start, grow or finance your business. If you are deemed eligible, a loan officer will contact you to begin the loan application process.
Submit To: The Entrepreneurship Center @CTI, Microloan Program, 165 Merrimack Street, Lowell, MA 01852


Please complete the form below to request more information.
Contact Information





Address
























Business Information

























IF YES, how many of:







If yes, how many:







How much were your business sales in the past three months?








Please list business assets (e.g. inventory, vehicles, and equipment). Attach additional pages if necessary.
The Entrepreneurship Center @CTI holds a blanket lien on all business assets if loan is approved.


Asset #1




Asset #2




Asset #3




Asset #4




Asset #5




Please list business debts (e.g. loans, credit cards or credit with suppliers).
#1




#2




#3




#4




#5




#6




Please list other property and/or assets (Personal or Business) you would like to list as collateral (e.g. home, automobile, land)


Item #1




Item #2




Item #3




The Entrepreneurship Center @CTI requires a Personal Guaranty for all loans.
Financial Information (Averaged By MONTH)
MONTHLY BUSINESS INCOME



MONTHLY PERSONAL INCOME









MONTHLY BUSINESS EXPENSES






















MONTHLY PERSONAL EXPENSES
















PERSONAL ASSETS







PERSONAL LOANS AND OTHER OBLIGATIONS

















ITEM & HOW IT WILL HELP YOUR BUSINESS









Business References (e.g. suppliers, clients, accountants)






Landlord References (if applicable)




Employer Reference (if you have a job outside your business)



How long have you worked there?



Eligibility, Agreements & Disclosures

If yes, please provide details separately.

If yes, please provide details separately.



If Yes to a, b, or c, explain in a separate statement.


Signature
I authorize The Entrepreneurship Center @CTI (E-Center) to make inquiries as necessary to verify the accuracy of the statements made and to determine my credit worthiness. Everything that has been stated in this application is correct to the best of my knowledge. I further promise that the proceeds of this loan will be used solely for the purposes outlined above and will not be used for any other purpose. I understand that the E-Center will retain this application, whether or not it is approved, for a period of at least three years from the date of signature. I authorize the E-Center to check my credit history/tax liabilities and to answer inquiries regarding my credit history/tax liabilities. I agree to notify the E-Center if there are any material changes in the information disclosed in the application or any accompanying statements.
I understand I will be working closely with the E-Center and will be required to receive technical assistance, including classes and one-on-one counseling, throughout the life of the loan. I understand that I will be required to provide financial statements (e.g. Profit and Loss Statements) as requested by the E-Center, monthly Bank Statements, and complete monthly business surveys throughout the life of the loan.
Loan applications are evaluated based on need for the loan, past or potential profitability of the business, character and management capacity of the applicant, credit history, collateral, and debt service. Loan approval is based on many factors and the E-Center reserves the right to not extend credit to any business and/or entrepreneur. The information you provide in this application will be held strictly confidential. This application will cease to be valid 60 days after the interview date




Contact Information