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Personal Information:
*
Full Name
*
Email
*
Phone Number
Business Information:
Have you been in business for at least 1 year?
Yes
No
*
Company Name
Address
*
City
*
State
Alabama
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South Carolina
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Zip
Type of Business
Accounting (CPA)
Agricultural
Apparel
Architect
Attorney
Automotive Parts
Automotive Service
Beverage
Bio-Tech
Chiropractor
Computer Hardware
Computer Software
Construction
Consulting
Consumer Products
Couriers / Messengers
Defence
Dental Technology
Dentist
Distribution
Dry Cleaner
Education Related
Electronics
Energy
Entertainment
Federal Government
Film, Play, Video
Financial Services
Fitness
Food Service
Forestry Fishing
Funeral Homes
Gaming
Garment
Gasoline Station
Health Care
Import / Export
Industrial Products
Insurance
Internet / Online Services
Laundry Mat
Legal Profession
Lodging
Manufacturing
Marine
Medical
Medical (Therapist)
Medical Technology
Mobile Home Parks
Mortician
Municipal
Natural Resources
New Technology
Optometry
Pharmacist
Pharmaceuticals
Printing
Psychologists
Publishing
Real Estate Related
Resorts
Restaurants
Retail
Security
Semi-Conductors
Service Related
Space Technology
Staffing
Telecommunications
Textiles
Titled Vehicles
Transportation
Trucking
Veterinary Technology
Veterinarian
Warehousing Storage
Waste Recycling
Wholesale
Other
Years in Operation
Less Than 1 Year
2 Years
3 Years
4 Years
5+ Years
eCommerce
Yes
No
Monthly VISA/MC
$0 - $2,000
$2,001 - $5,000
$5,001 - $10,000
$10,001 - $20,000
$20,001 - $30,000
$30,001 - $40,000
$40,001 - $50,000
$50,000 - $100,000
Over $100,000
Yearly Gross Sales
Less than $500,000
$500,000 - $1 Million
$1 Million - $2.5 Million
$2.5 Million - $5 Million
$5 Million - $10 Million
$10 Million - $20 Million
$20 Million - $50 Million
$50 Million - $100 Million
Greater than $100 Million
Use of Cash
Business Working Capital
Equipment purchase
Remodeling/Upgrades
Product Development
Training
Trade Show Participation
Expansion
New Location
Buying a Business Partners Interest
Business Taxes
Payroll
Buying Inventory
Temporary Staffing
Other
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