Getting Started Questionnaire for Funding & Services

How did you hear about Nebraska Enterprise Fund? *

Please describe other referral source: *

Name *

First

Last

Address *

Include street, city, state, ZIP, and county

City *

State *

Zip Code *

Email *

Cell Phone Number (no dashes/spaces) *

Gender *

Race *

Ethnicity *

Phone is a

Country of Origin *

Example: United States

Are you or an immediate family member a veteran, a National Guard or Reserve member, or a military spouse? *

If you answered yes above:

You will be directed to an external website after your submission below that is managed by the Small Business Association’s (SBA) Veterans Business Outreach Center (VBOC), where you will signup for a new account with the SBA-VBOC NEOSERRA Platform. A Nebraska Enterprise Fund VBOC team member will be reaching out to you after your submission.

What services are you looking for? *

FLEX Loan Disclaimer

The FLEX Loan does require a credit score of 600 or higher. We highly recommend you agree to a SOFT CREDIT pull below. This will not impact your credit.

Business Name and DBA *

Please enter N/A if not established yet.

Do you already have a business established? *

What stage is your business currently in? *

Percentage of the business ownership that is Female: *

Percentage of the business ownership that is Male: *

Do you have a business plan? *

Do you have financial projections? *

Have you filed your most recent personal and/or business tax returns? *

Do you already have a business bank account? *

Do you currently have any other business loans or business debt? *

If Requesting Capital (Business Loans) *

Please describe the capital amount requested List loan purposes /uses by $ amount. FOR EXAMPLE: $ 20,000 for Purpose: Working Capital & Equipment What is the minimum amount you can work with and what will the purpose be $ for Purpose?

What is your current credit score range? *

Do you Agree to Complete a Prequalification Soft Credit Pull? (Submitting this will NOT impact your credit score) *

Submitting this form will NOT impact your credit score. I hereby authorize Nebraska Enterprise Fund to access my credit report on the date below for purposes of providing me with financial counseling and for inclusion in depersonalized/anonymized data within Member Outcome Reporting used to track aggregate consumer financial progress. I understand that this inquiry into my credit constitutes a “soft inquiry” and will not adversely affect my credit or credit rating. While this credit report and score pulled by Nebraska Enterprise Fund on my behalf will be used to provide me with financial counseling, it is understood that I will not receive a copy of this credit report. Notwithstanding the foregoing, I understand that I have the right to dispute information with the credit bureau, to request reinvestigation, and to have corrected reports reissued to previous recipients of this credit report, if warranted. I understand that credit information is sensitive and that there may be inherent risks to accessing such data; I have had the opportunity to ask the Nebraska Enterprise Fund staff any questions regarding such risks. I further understand that all my personal information will be held confidential by Nebraska Enterprise Fund.

Date of Birth *

Social Security Number *

Notes

Please let us know if you have other questions or needs.

REQUIRED: Please use your finger or mouse to complete your Signature *

Clear Signature

I request business assistance in the form of a micro-loan, training, and/or business technical assistance or counseling from the Nebraska Enterprise Fund or one or more of its program partners. I agree to participate should I or my business be selected to participate in follow-up surveys designed to evaluate NEF or its partner services. I understand that any information disclosed will be held in strict confidence by NEF staff, the NEF loan committee and by any NEF resource partner. In consideration of the counselor(s) working for NEF or its partners furnishing management or technical assistance, I waive all claims against NEF personnel, and that of its resource partners and host organizations, arising from this assistance.

Getting Started Questionnaire for Funding & Services

If you are looking for funding, there will be a formal application that will need to be completed in addition to this form.

If you answered yes above:

FLEX Loan Disclaimer