ICNC | Microloan Credit Application

Company*
Incorporation Date*
Type of Business*
NAICS Code*
NAICS is a standardized industry classification system. If you don't know the code for your industry, you may search for it here.
Website
Phone*
Email*
Business Address
Street AddressAddress Line 2CityStateZip Code
Current Number of Employees (including owner)*
Please enter a value between 1 and 500.
How many additional Employees, if any, do you plan to hire in the next 12 months?
Please enter a value between 0 and 500.
Last Year's Revenue
Please enter a value greater than or equal to 0.
This Year's Revenue*
Please enter a value greater than or equal to 0.
Business Nature*
Briefly describe the nature of your business, products, and clientele.
Have you applied to ICNC's Microloan Fund or Revolving Loan Fund before?*
- Yes
- No
Have you been denied a loan from any entity in the past year?
- Yes
- No

Your Name*
FirstLast
Home Phone
Email
Home Address*
Street AddressAddress Line 2CityStateZip Code
Partners
Please list the names of any associates with a 20% or greater interest in your company.

Loan Amount Requested*
Please enter a value between 0 and 25000.
The maximum loan amount disbursed to any business is $25,000.
Please describe the activities for which the loan funds will be used.*
Will any new jobs be created as a result of this loan?*
- Yes
- No
How many new jobs will be created?
Please enter a value between 1 and 50.

Please describe any outstanding debts your business owes.
This may include credit cards, loaned equipment, or other loans.
Creditor
Outstanding Amount
Monthly Payment
Months left
Creditor
Outstanding Amount
Monthly Payment
Months left
Creditor
Outstanding Amount
Monthly Payment
Months left
Section Break
VERIFICATION*
- I attest that the information provided in this application is complete and accurate.
Initial*
Date*
MM
DD
YYYY

Microloan Credit Application