Loan Inquiry Form
How did you hear about MESO/Loan Products?
Business Owner
Bank/Financial Institution
Community Member
Community Organization
MESO Staff Member
Social Media
Other
Community Organization that referred you
Please select...
Craft3
Hispanic Metropolitan Chamber (HMC)
Immigrant and Refugee Community Organization (IRCO)
Livelihood NW (BOP)
Mercatus
MicroEnterprise Resources, Initiatives, and Training (MERIT)
MicroEnterprise Services Of Oregon (MESO)
Native American Youth and Family Center (NAYA)
Neighborhood House
NuProject
Oregon Native American Chamber (ONAC)
Oregon Office of Small Business Assistance
Portland Incubator Experiment (PIE)
Prosper Portland
SCORE
The City of Forest Grove
The City of Tigard
The Indus Entrepreneurs Oregon (TiE Oregon)
Venture Portland
XXcelerate
Other (write in below)
Name of Bank/Financial Institution
Please select...
Bank of America
Banner Bank
Beneficial State Bank
Chase
First Security Bank
Heritage Bank
Key Bank
OnPoint Community Credit Union
Point West
Rivermark Credit Union
Umpqua
US Bank
Washington Trust Bank
Wells Fargo
Other
Other Referral Source/Name
Name of person/advisor who referred you
Referrer ID
Personal Information
First Name
Last Name
Preferred email
Please select...
Personal
Work
Alternate
Email
Preferred phone
Please select...
Mobile
Work
Home
Home Phone
Work Phone
Mobile Phone
SMS Ok? (message and data rates from your carrier may apply)
Please select...
Yes
No
Demographic Information
Please note, we collect demographic information to better understand our client base and community impact.
Gender
Please select...
Male
Female
Transgender
Non-binary
Choose not to identify
Race/Ethnicity
Please select...
African-American or Black
American Indian/Alaskan Native
Asian
Hispanic or Latino
Native Hawaiian/Pacific Islander
White
Other
Prefer not to answer
Ethnicity
Please select...
Hispanic or Latino
Not Hispanic or Latino
Prefer not to answer
Are you a US Citizen?
Yes
No
(U.S. citizenship is not a requirement for submitting a loan application or for loan approval)
Business Info
Fill out as much as you can of the non-required fields. Required fields have an asterisk (*) next to them.
Name of business
Nature/description of business
Business address
Business city
Business state
Please select...
Oregon
Washington
Business zip/postal code
Business phone
Business email
Business website
Gross annual revenue (last 12 months)
$
Years in business?
Startup
Less than 6 months
6 months - 1 year
1 year - 3 years
3 years - 5 years
5+ years
Do you have a written business plan?
Please select...
Yes
No
How much total funding are you requesting?
$
No cents or dollar sign "$" allowed in this field. Acceptable values look like "100" or "25000" up to 500K.
Can you provide financial reports for your business?
Please select...
Yes
No
Unsure
Use of loan proceeds (including $ amounts)?
How will these funds affect your business?
Select the following you have available for collateral
Property
Vehicle
Personal Guarantor
Business Assets
Other
Other available collateral
Have you applied for a business loan before?
Please select...
Yes
No
Any additional information you would like us to know?
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Contact Information