LISC Small Business Pre-Screen Form

Thank you for your interest in a small business loan through the Local Initiatives Support Corporation (LISC). This form allows us to prescreen your loan request; additional information will be required after an initial review. Please contact Claudia Gomez, Loan Processor, at cgomez@LISCsb.org if you have questions.

Save & Return

Save your progress and complete this form later. (optional)

Company Information

Is your business a franchise? *

Individual Information

Are you a veteran? *
Were you discharged honorably?
Are you a citizen of the United States? *
If you are not a U.S. citizen, please send a scanned photocopy of your Resident Alien Card or Permanent Resident Card (Form I-551) as evidence of your permanent resident alien (LPR) status to cgomez@liscsb.org.
Or please upload a copy of the file below: 

 
Please note: At this time, our minimum credit score is 625.

Business Ownership Structure

SBA Eligibility Questions

If you answer "yes" to any of the questions below, you must either upload a written lettter of explanation (see end of section) or email additional written explanation to Claudia Gomez at cgomez@liscsb.org. Failure to provide this additional explanation will delay your application. Please include your name and your business name in this email.
Do you have any affiliated companies? *
Have you or any other principals of your company been involved in any bankruptcy or insolvency proceedings? *
Are you or any other principals of your company involved in any pending lawsuits? *
Are any of your personal or business tax obligations past due? *
Have you been arrested in the past six months for any criminal offense? *
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction? *
For any criminal offense - other than a minor vehicle violation - have you ever: 1) been convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed on pretrial diversion; 5) been placed on any form of parole or probation (including probation before judgement)? *
If you answered "yes" to any of the questions above, please email additional written explanation to Claudia Gomez at cgomez@liscsb.org or upload a written explanation below:

 

Business Experience

Do you have at least two years of recent, direct experience in the industry in which you are requesting financing? *
After an initial review and completion of the intake process, you will be asked to provide a resume with proof of direct industry experience.
Most recent employment experience:

LOAN PURPOSE

USE OF LOAN PROCEEDS:
Enter a dollar amount for all applicable items:
TOTAL PROJECT COST:
$0.00
Please note that start-up business requests are required to provide a minimum down payment of 30% of the total project cost; business acquisition requests - 20% ; existing business requests - 10%.
 
Note: At this time, LISC provides loans between $50,000 and $250,000.

Certification and Signature

Certification is to be completed by each person submitting the information requested on this form.
 
I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.  

By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted with this form is true and complete to the best of my knowledge. I understand that SBA or its participating Lenders or Certified Development Companies or Surety Companies will rely on this information when making decisions regarding an application for a loan or a surety bond. I further certify that I have read the attached statements required by law and executive order.  I hereby certify that: (1) as consideration for any Management, Technical, and Business Development Assistance that may be provided, I waive all claims against SBA and its consultants, and (2) all information contained in this document and any attachments is true and correct to the best of my knowledge.
Signature 1 *
clear
Signature 2
clear