Intake Form- Build Fund

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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

First Name

Middle Name

Last Name

Email

Phone Number

What programs are you Interested in?

What will loan be used for

Provide a description of how the loan will be used?

Personal Income Level

How many person(s) are actively living in your household?

Business Name

Have you operated or owned a business with any other name?

If yes, what was the name used?

Legal Form

Business Address

Street

Address Line 2

City

State

Zip Code

Business Website

Is this business certified with the City of Indianapolis as any of the following?:

Female-Owned

Military Veteran-Owned

Disability-Owned

Disadvantaged-Owned

Industry

Please Specify Other industry

Loan amount requested?

Do not to include commas, decimals, or $

Annual Business Revenue?

Do not to include commas, decimals, or $

Is this business a start-up?

Please indicate the number of existing employees:

Please enter numbers only

Projected number of jobs to be created?

Please enter numbers only

Demographics:

Race: Check one or more

Ethnicity: Hispanic or Latino

Sex

Are you a Veteran?

How did you hear about Build Fund or Intend Indiana?

Project Portfolio

For Acquisition Loans - Purchase Agreement

Business Plan

Active Business License in Indiana from the Secretary of State

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Contact Information