Online Application State where your business is located: Select a State Outside U.S. AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Business Name: Your First Name: Your Last Name: Address 1: Address 2: City: State: Zip: Day Time Phone: Fax: E-Mail: Your position in the business: Business Position Sole Owner Majority Owner Minority Owner General Manager / Not Owner Financial Manager Employee What industry are you currently in? Select an Industry Adult CareProviders Assisted Living Centers Auto Repair Shops Car Washes Child Care Providers Gas Stations/Convenience Stores Hotels/Motels Manufacturers Professional Service Providers Recreation Facilities Retailers Restaurants Other If other: How long has your company been in business? Select the Number of Years Start-up 1-3 years 3-5 years 5-8 years More than 8 years How many years of experience do you personally have in this business or industry? Select the Number of Years 1-3 years 3-5 years 5-8 years More than 8 years How many employees do you have? Select the Number of Employees 1-50 50-100 100-200 200-300 300-400 400-500 Over 500 Does the business rent or own the building in which it will operate? Rent Own What are your annual sales? Select This Year's Sales $0-$500,000 $500,000-$1,000,000 $1,000,000-$3,000,000 $3,000,000-$5,000,000 $5,000,000-$10,000,000 Over $10,000,000 What is the loan amount you want? What will the loan be used for? Select one or more of the purposes. Select a Purpose Purchase or construct real estate Refinance existing debt Working capital Renovate existing property Purchase machinery, equipment, furniture, fixtures Purchase a business or buyout existing shareholders Other Select a Purpose Purchase or construct real estate Refinance existing debt Working capital Renovate existing property Purchase machinery, equipment, furniture, fixtures Purchase a business or buyout existing shareholders Other Select a Purpose Purchase or construct real estate Refinance existing debt Working capital Renovate existing property Purchase machinery, equipment, furniture, fixtures Purchase a business or buyout existing shareholders Other Select a Purpose Purchase or construct real estate Refinance existing debt Working capital Renovate existing property Purchase machinery, equipment, furniture, fixtures Purchase a business or buyout existing shareholders Other Have any of the owners been arrested or convicted of any criminal offense other than a minor traffic violation in the last ten years?: Yes No If Yes: How did you learn about WPI Financial Services? Select Here Business Week Electronic Accountant Idea Café Quicken On-line Directory Accountant/lawyer/associate LiveCapital.Com GoTo.com Yahoo Excite Hot Bot Lycos Alta Vista MSN.com Other If other: Referring Company Referring Associate Tell us more about your business in the following section: After you have completed the questionnaire, press the submit button.
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