New Client Inquiry – Southern Oregon – Region #4 CAT New Client Inquiry – Southern Oregon – Region #4 (Counties: Coos, Douglas, Curry, Josephine, Jackson) Name* First Last Company Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Please tell us a little about your business...Are you a start-up or an existing business?*Start-UpExisting BuisnessHow many years has this business operated?What industry/sector is the business part of?*What type of business is it?*Number of full-time employees?*Number of part-time employees?*How much capital are you looking for?*Reason for capital?*StartGrowRefinanceDisaster AssistanceHow much cash do you have available to invest in this business?*Have you been denied access to capital by a lender?*YesNoWhat is your timeline for your capital needs?*Now1 month3 months6 months9 months12 monthsUsing a 5-star rating, how would you rate your credit score?* 1 star 2 stars 3 stars 4 stars 5 stars (1 = less than good) (5 = excellent)Please share your current level of readiness to seek financing and work with the Capital Access Team:I have an updated business plan.*YesNoNot ApplicableI have 24 months of month-by-month financial projections.*YesNoNot ApplicableI have 3 years of personal tax returns.*YesNoNot ApplicableI have 3 years of business tax returns (for this existing business).*YesNoNot ApplicableI have completed an updated Personal Financial Statement.*YesNoNot ApplicableI have my credit report available to review.*YesNoNot ApplicableAre you currently working with your local Small Business Development Center (SBDC) on getting funded?*YesNoHow did you learn about the OSBDCN's Capital Access Team?*Referral from my SBDC advisorReferral from my bankerPersonal researchReferral from economic development professionalReferral from another clientIf you received a referral to the Capital Access Team, please share specifically who referred you and from where.Example: (Jeff Jacobs - SBDC Advisor - Lane Community College SBDC - Eugene)EmailThis field is for validation purposes and should be left unchanged.