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NEXT STEP LOAN FUND APPLICATION

LOANQUESTIONNAIRE
QUESTIONNAIRE
LOAN
Your name: _______________________

Name of business: _________________________

Phone number: ______________________ Best time to reach you:______________________


Email: __________________________ Address: _____________________________________

A. About Your Business and Business Plan


Have you been in business before? YES [ ]

NO [ ]

If YES, tell us about your business. _________________________________________________________

_________________________________________________________________
Who are your customers? __________________________________________________________________

_________________________________________________________________
Are you profitable? _______________________________________________________________________

_________________________________________________________________
What excites you about your business right now? _______________________________________________

_________________________________________________________________
What keeps you awake at night?_____________________________________________________________

_________________________________________________________________
What barriers do you see that could get in the way of your business success? ________________________
______________________________________________________________________________________
Where do you sell your product or services and who is your competition? ___________________________
_______________________________________________________________________________________

If NO, give us your background. What experience do you have that would make this proposed business
successful? ______________________________________________________________________________

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

B. About the Loan

How much do you want to borrow? $_________________ Proposed Payment $___________________


Proposed Term (# Months/Years) ____________________
Describe how you will use the loan funds and how this investment will help your business? ______________
________________________________________________________________________________________
Will a Next Step Loan cover the full cost of the project, and if not, what other funds will help you get the job
done? __________________________________________________________________________________
________________________________________________________________________________________
How will you make the money to repay this loan? ________________________________________________
_________________________________________________________________________________________

What is your current monthly income? ____________________ Describe how that will be changing as a result
of this business venture. _____________________________________________________________________
_________________________________________________________________________________________
Please provide documentation for all sources of current income (paystubs, tax returns, bank statements, etc.)
Are you in business by yourself? YES [ ] NO [ ]
Do you have a partner? YES [ ]

NO [ ] If yes, who is your partner or partners? _____________________

_________________________________________________________________________________________
Have you filed business tax returns? YES [ ]

NO [ ] Personal tax returns? YES [ ] NO [ ]

If yes, please provide the most recent copy of your business and/or personal filed tax returns.

Please provide any documents that show your business is growing or has the potential to grow. For example,
what is your marketing plan? Do you have bank statements that show your cash flow? If so, please provide
copies and attach any additional information that will help us make this loan decision.

C. Your Credit History


1. Please list the amount and terms of all current loans including personal debt
Name of Creditor

Monthly PMT

Account #

Term

2. If you have not established a traditional credit history, please provide alternative documentation to show
your payment history for monthly obligations such as rent, telephone, electricity, etc.
3. Please give us the names and phone numbers of people who would vouch for your credit worthiness
(minimum of two references).
Name of Reference

Telephone Number

Relationship

4. Please give us two trade/business references, and their phone numbers.


Name of Reference

Telephone Number

Relationship

D. General:
5.

Who are your suppliers?


Name

Telephone Number

6.

Do you have any employees? How many? ____________________________________

7.

Do you have property and liability insurance? [ ] Yes [ ] No

If yes, please provide the following information


Name of provider

Account #

Amt of Coverage

Telephone Number

8.

Have you or your business partners ever:


Been convicted of a felony? [ ] Yes [ ] No
Filed for bankruptcy? [ ] Yes [ ] No
Had any of your business property foreclosed upon? [ ] Yes [ ] No
Are any lawsuits or administrative proceedings now pending or threatened against you or your
business? [ ] Yes [ ] No

9. If any of the questions in #4 have been answered "Yes", please provide


details._____________________________________________________________________

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
E. Is there other information you feel is important for us to know about your business or background? Please
attach any documents that may help us evaluate your loan request.
__________________________________________________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
F. How did you find out about us? _____________________________________________________________

___________________________________________________________________
G. Please sign the statement below to give us permission to contact your creditors:
Date: __________________________
In connection with my loan application to the Next Step Loan Fund I/(we) hereby authorize The Opportunity
Alliance to verify and collect credit information including, but not limited to, bank references and trade and
credit references.
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Signature(s)/Title(s): _______________________________________________

____________________________
Printed Name(s):

_______________________________________________

____________________________
Name of Business:

_______________________________________________
Submit Application

Revised: 9/26/2013

Print Application

Application Checklist

Completed Application: [ ]
Completed Signature Page: [ ]
Electronic attachments or hard copies of requested financial documents: [ ]

Once you have completed your application, you can submit electronically, or mail a hard copy.
When you push the 'submit application' button, your email program will open, allowing you to
attach electronic copies of the requested financial documents to the email before sending.
If you are mailing your application, use the 'print' button to print out your application; make
sure to sign the signature page and include photocopies of the requested financial documents
with your application.

Mailing address:
The Opportunity Alliance
Next Step Loan Committee
50 Monument Square, 6th Fl
Portland ME 04101
If you have any questions, email: info@opportunityalliance.org, or call Christine Stelling, SVP of
Development and Communications: 523-5030