Contact Us
Contact Us
First Name
*
Last Name
*
Phone Number
Phone Number
*
-
###
-
###
####
Email
*
Company Name
*
State/Province
*
What does your business do?
*
Are you an Amazon Seller?
*
Are you an Amazon Seller?
Yes
No
Did you receive an Amazon Community Lending pilot program offer?
*
Did you receive an Amazon Community Lending pilot program offer?
Yes
No
Unsure
N/A, not an Amazon Seller
Gross Annual Revenue
*
Gross Annual Revenue
$0-$50K
$50K-$200K
$200K-$500K
$500K-$750K
$750K+
Use of Funds (check all that apply)
*
Use of Funds (check all that apply)
Acquire Another Business
Advertising/Marketing
Consolidate Debt
Develop a New Product
Equipment Purchase
Hire New Staff
Inventory Purchase
Open a New Location
Remodel Current Location
Leasehold Improvement
Tenant Improvement
Other
Other
Requested Amount
*
$
Dollars
.
Cents
How did you hear about us?
*