Member of the Lake Agassiz Development Group
Simply fill out the form and send by clicking Submit at the bottom of the page.
Fields with an
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are required.
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Business Name:
*
Contact Person:
*
Address:
*
City:
*
State:
*
Zip:
*
Telephone:
Fax:
*
E-mail:
BUSINESS INFORMATION
Type of Business Organization
Partnership
Sole Proprietorship
LLC
S Corporation
C Corporation
Other
Nature of Business
Business Tax ID Number
Business Net Worth
$
Business Net Income
$
Business Number of Employees
Current
Projected over next two years
USE OF PROCEEDS
Purchase of existing building and land
$
Construction of new building
$
Land acquisition and/or land improvements
$
Renovation or expansion of existing building
$
Equipment purchases
$
BANK INFORMATION
Bank Name
Bank Officer
Bank Location
Phone
Fax
Officer e-mail (if known)
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