Bankers Referral Form

I. Referral Bank Information
Please tell us who you are. (*required information)





II. Prospective Client Information:
Please tell us about the client.














Best time to contact the client:
Morning
Afternoon

III. Requested Loan Information
Please tell us a little more so that we are able to better serve the client.

This client is a/an:
Start-up business (less that one year) requiring less than $15,000.
Established business (more than one year) requiring up to $50,000.

IV. Loan Purpose
Please choose the following options to help us understand how the client will use loan funds. Check all that apply.

Working Capital
Inventory
Furniture
Equipment
Partnership Loan
Fixtures

WARNING: Please review your information before submitting. Once you have clicked "Submit" you will not be able to change the information.


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