The Enterprise Center Capital Corporation
4548 Market Street Philadelphia, PA 19139 (215) 895-4024 • Fax (215) 895-4001
ASSESSMENT AND BUSINESS PROFILE
The following information is collected in order to assess your business’s need for financing and/or technical assistance. Any information provided here or during assessment appointments will be held in strict confidence. Date:____________________ 1. Business Name or Idea _______________________________________________________________________________ Business Address _______________________________ City __________________State _____Zip ________ Business Phone __(____)______-______ Business Fax__(____)______-______
Business Email ______________________________ Owner’s Name Mr./Ms. ______________________________________________________________________________ Home Address _________________________________ City __________________State _____Zip ________ Home Phone __(____)______-______ Alt. Number__(____)______-______ Home Fax __(____)______-______ Email ________________________________
2.
3.
How would you describe your venture (circle one)? Pre-venture Startup Existing Mature
If Existing or Mature, how long have you been in business? ____________________________________________
4.
What is your business structure (circle one)? Sole Proprietorship Partnership LLC LLP Corporation Other
If Other, please explain __________________________________________________________________________
5.
What type of business are you engaged in or interested in starting (circle one)? Retail Service Wholesale Manufacturing Construction Other
If Other, please explain __________________________________________________________________________
6.
Describe your product or service __________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
7.
If applicable, please list your business revenue for the last three years: Year 1 _______________ Year 2 _______________ Year 3 _______________ Has your business been profitable? ________________________________________________________________
The Enterprise Center Capital Corporation Page 1 of 3
8.
How many employees do you have, including yourself? ____________________________________________________
9.
Do you use accounting software (circle one)?
Yes
No
If so, which package? _________________________________
10. Do you have an accountant or CPA (circle one)?
Yes
No
11. What size loan are you requesting? _________________________________________________________________
12. How will the loan be used? _____ ____________
__________________________________________________
_______________________________________________________________________________________________
13. How much cash are you injecting into the loan? _____________________________________________
14. Approximately what is your personal credit score (circle one)? Excellent (720 - 850) Good (680 - 719) Fair (640 -680) Poor (350 - 640)
Please provide any further details, if necessary ______________________________________________ ________ _______________________________________________________________________________________________
15. Approximately what is your D&B Paydex score (circle one)? 20 30 40 50 60 70 80 90 100
Please provide any further details, if necessary ____________________ __________________________________ _______________________________________________________________________________________________
16. What is your educational level (circle one)? High School/GED Associate Degree Bachelor Degree Graduate Degree Trade School Other
If Other, please explain __________________________________________________________________________
17. What is your current employment status? __________________________________________________________
18. What is your income level (circle one)? $0-10,000 $10,000-20,000 $20,000-40,000 $40,000+
19. How did you hear about The Enterprise Center Capital Corporation? ___________________________________
20. What Districts does your business reside in? Congressional_________________ Senatorial __________________
The Enterprise Center Capital Corporation • 4548 Market Street • Philadelphia, PA 19139 • (215) 895-4024 • Fax (215) 895-4001 Page 2 of 3
The following information is collected for census purposes only and will not be used when evaluating your business for loans or technical assistance. The Enterprise Center Capital Corporation (TECCC) is an Equal Opportunity Lender. TECCC provides technical assistance, makes loans, and extends credit without regard to race, color, religion, sex, marital status, age, disability, or national origin. Please complete the following regarding the owner or primary stakeholder of the business.
1. ________Female ________Male
2. Date of birth ________________________________________________________ Month Day Year 3. What is your ethnic background (circle one)? Black or African American Eskimo or Aleutian Native American Asian or Asian American Hispanic or Latino
Non-Hispanic White
Two or More Races
Other _________________________________________
4. Are you Disabled? ___________________________________________________________________________________ 5. Are you a Veteran? __________________________________________________________________________________
For Staff Use Only
PYEP/SBA/Other_________________________ LOP____________________________________ L/TA/O_____________________________ REF________________________________
The Enterprise Center Capital Corporation • 4548 Market Street • Philadelphia, PA 19139 • (215) 895-4024 • Fax (215) 895-4001 Page 3 of 3