MobilizeSTL Contractor & Supplier Loans Questionnaire Name of Business: Email: Phone: How did you hear about the product?: --None-- Social Media Friend Family City Employee Other If other, please describe.: Funds to Bonding/Insurance?: --None-- Yes No Initial Contract Mobilization: --None-- Yes No Year in Business: --None-- 0 - 1 years 1 - 3 years 4 - 7 years 8 years or more Non-Profit or For Profit: --None-- Non-Profit For Profit What is the intended use of funds?: --None-- working capital constructions lines of credit term loans owner occupied commercial real estate investment real estate loans Business Street Address: Business City: Business State: Business Zip: Business Owner First Name: Business Owner Last Name: Business Owner Email: Business Owner Contact Number: Business Owner Home Street Address: Business Owner Home City: Business Owner Home State: Business Owner Home Zip: Is the business a WBE or MBE?: --None-- WBE MBE WMBE No Is the business a certified WBE or MBE?: --None-- WBE MBE WMBE No If yes, what agency?: Do you have your personal credit report?: --None-- Yes No Credit Score: --None-- 0 - 550 551 - 599 600 - 650 651 - 750 751+ Are Income taxes curent?: --None-- Yes No Business has a positive net worth?: --None-- Yes No Do you have collateral to secure a loan?: --None-- Yes No Filed personal & business income taxes?: --None-- Yes No What is the most recent year filed?: --None-- 2023 2022 2021 2020 2019 What is the 2nd most recent year filed?: --None-- 2023 2022 2021 2020 2019 What is the 3rd most recent year filed?: --None-- 2023 2022 2021 2020 2019 Signed contract to provide services?: --None-- Yes No What is the value of a contract?: If yes, name of company: If you are approved to receive funding from this program, would you be willing to have your experience featured for SLDC’s marketing and promotional purposes? --None-- Yes No
