Request Application - Torchlight Minority Small Business Incubator

Full, exact legal name of Company and any Trode styles or Doing Business As (dba)

Description of Business

Address

Address Line 1

Address Line 2

City

State

Zip Code

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Phone Number

Fax Number

Email *

Website

State of "Organization/Type/Yecr Organized

Federal Employers ID Number

DUNS Number

Sales in Last Full Year

Estimated Sales in Current Year

Name of Owner/CEO/President

Home Address

Name(s) and SSN # of Majority Owner(s)/% Owned (list all owners >= 20%)

Home address(s)

Name of Principal Bank of Business

Contect Name and Number

CPA firm

Contact Name and Number

Current Lending Arrangements

Do you outsource your payroll?

Yes
No

Number of Employees

Who is your provider? Include Contact and phone

Has your Business declared bankruptcy, granted on assignment for the benefit of creditors, had property, foreclosed, or given a deed in lieu or been reorganized in the past , years? Has the Majority Owner(s)?

Yes
No

Does your payroll provider remit all employee-related tax, payments on your behalf?

Yes
No

Are there any other liens or judgments on your Buniness? De the Majority Owner(s)?

Yes
No

Have any of the Majority Owners been involved with another business venture that has declared bankruptcy, granted an assignment for the benefit of creditors, hed property) foreclosed, or given a deed in Neu or been reorganized in the past 7 years?

Yes
No

Is the Business party to any lawsults?

Yes
No

Is the Business delinquent or in default of any debt or other loans?

Yes
No

las the Majority Owner(s) party to any lawsuits or delinquent or in default of any debt or other loan?

Yes
No

Is your company Minority Owned and Operated? (if yes please provide certification) (Upload box)

Yes
No

What is your primary skill/trade?

Are you primarily a GC or Subcontractor?

General Contractor
Subcontractor

How many active projects is your company currently engaged on?

What is the largest contract you've completed? (Brief description)

Are you Bonded?

Yes
No

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Who is Bonding your Company?

What is your max project bond limit?

What is your total bond Aggregate?

Do you need help with bonding?

Yes
No

Do you take daily project notes on your projects?

Yes
No

Who is your Lead M/Superintendent? (provide contact info)

Name *

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Phone

Email *

What are the things you company currently needs?

How much does your company need to borrow?

Where does the bulk of your work come from?

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Federal (%)

Selected Value: 0

Commercial (%)

Selected Value: 0

Private (%)

Selected Value: 0

Public (%)

Selected Value: 0

What are barriers to company growth?

How much contract work do you have scheduled this year?

Do you perform a large amount of union work?

Name of Union *

Union Rep

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Phone

Email *

Are you current on your union dues?

Yes
No

Please sign and provide this application along with the Source Documents on the ettached list. Your signature constitutes a representation and warranty that the above information is true and correct In all material respects and authorizes us to conduct our due diligence and process your credit request, including contacting any references listed and investigating the personal credit history of shareholders, officers and authorized signers.

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Signature

Date