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Technical Assistance and Loan Application
Business Introduction Profile
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Email
*
Your email
Applying For:
*
Technical Assistance
Loan
Other:
Required
Business Name:
*
Your answer
Business Owner's Name:
*
Your answer
Business Owner's Home Address:
*
Your answer
Email:
Your answer
Owner's Contact Number
*
Your answer
Business Address
*
Your answer
Web Address:
Your answer
Business Phone:
*
Your answer
Year Business Started
MM
/
DD
/
YYYY
Type of Business
*
Your answer
Industry:
Your answer
Product/Services Offered:
Your answer
Number of Employees
Your answer
Full Time:
*
Your answer
Part Time:
*
Your answer
Who is Your Primary Customer:
Your answer
Challenges/Obstacles Facing Your Business:
*
Your answer
Gross Sales Last Full Year:
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Your answer
Plans for Growth/Expansion Over Next 2 Years:
Your answer
If Applying For a Loan, How Would You Use the Funds?
Your answer
Primary Language Spoken:
*
Your answer
Household Size:
Your answer
Household Gross Income:
Less Than $50k
$50-60k
$61-70k
$71k Or More
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Business Owner's Digital Signature
*
Your answer
Rhode Island Black Business Association: (401) 383-1179, RIBBA TA/Loan Application, 3 Regency Plaza, Suite 3E, Providence, RI 02903, SmallBizHelp@RI-BBA.org
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