Revenue-Based Financing Form

November 2, 2022

Lending Intake Form

Hello and welcome! We are excited that you are interested in working with CIC. We provide loans and business education to small businesses located in Southern Arizona, namely Pima, Cochise, Graham, Greenlee, Pinal, Santa Cruz, and Yuma counties. If your business is located in one of those counties, you are in the right place!

Our inquiry form is a little different from what you may be used to. We know that your time is valuable and if we are not able to help you, we want to let you know as soon as possible. Our form is dynamic and will provide you with information as you answer questions, letting you know right away if we might not be a good fit. We’ll collect your contact information at the end of the form.

If you are interested in continuing on, please read more about our services below and let us know which service(s) is of interest.

Business Loans – We make loans of $500 – $100,000 to small businesses located in Southern Arizona with a special focus on microloans and loans to entrepreneurs of color.
- The BIPOC Community Managed Loan Fund offers microloans of up to $10,000 specifically for entrepreneurs of color.
Business Education – We provide no cost training and coaching to help you prepare for a loan, determine what type of funding might be best for your business, and put your application package together.
Success Through Alternative Capital (STAC) aims to help businesses without adequate collateral or assets to qualify for traditional loans. This new initiative comes after years of serving business owners with credit challenges who sought different financing options, beyond fixed-term loans.

Please note that your information is saved on our secured server as you complete this form.

What types of services are you interested in? (Check all that apply.)(Required)

My business needs a loan.

I need business education.

I want to apply for the BIPOC Loan Fund.

I am interested in revenue-based financing with STAC.

I need a personal loan.

Not sure. I need more information first.

*Please note that we only make loans to businesses. If you are in need of a personal loan, please contact your bank or credit union.

If you select other service(s), you may continue your inquiry.

Personal Loan Attestation(Required)

I understand that CIC does not make personal loans, but I will proceed to learn about other support options.

Need more information? Please view the pages below to learn about growing your small business.

Click here to learn more about CIC’s Small Business Loans.

Interested in the BIPOC Loan Fund? Click here to learn more about this program for business owners of color.

Click hear to learn more about STAC, a Revenue-Based Financing Initiative for Small Businesses.

Click here to find more tools for starting your Small Business.

Click here to learn more about the basics of Business Finances.

How do loans work? Click here to learn more.

If you are ready to continue your inquiry, please uncheck “Not sure. I need more information first.”

We primarily serve businesses located in southern Arizona. In what county is your business located?(Required)

We’re sorry, but as a nonprofit lender serving Southern Arizona, it sounds like your business would likely not qualify. If you are based elsewhere, but a significant portion of your business serves one of the above listed counties, please select that county to continue this form.

Because you are interested in multiple services with CIC, this form will ask you questions about each service you selected.

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Loan Inquiry Questions: Phase 1

What size loan are you interested in?(Required)

CIC provides microloans and BIPOC Loans of $10,000 or less, and standard loans of up to $100,000.

Please enter a number greater than or equal to 0.

*NOTE: If you are interested in applying to the BIPOC Loan Fund, please decrease your loan amount to $10,000 or less.

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Loan in Thousands – Hidden

Used for Pipedrive Deal Name.

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Deal Value – Hidden

Used for Pipedrive

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Close to a microloan number – Hidden

This is an admin field that allows us to give them the option of reconsidering a microloan if they are in the ballpark (>$10K but ≤$15K).

Hey, just a quick note!

We do make loans this size, but we have an easier-to-access loan program for loans up to $10,000. Feel free to stick with your answer, but if you reduce to $10,000 or less, we may have additional options for you. 

How soon do you need a loan?(Required)

Loan applications with CIC typically take 1 – 2 months to process depending on the complexity of the application.

Less than 4 weeks from now

1-2 months from now (or more)

*Loan application typically take at least 4 weeks to process. If you do not have at least 4 weeks, CIC is not the right fit. If you have more than 4 weeks, please select the 1 – 2 months option.

Loan Options

Based on your answers and requested loan size, CIC may have two business loan options for you.

We manage a revolving Loan Program (available across Southern Arizona) where payments from each active loan are used to fund future loans. Based on your responses, you may be eligible for a Microloan ($500 – $10,000).
We also have an interest-free loan fund specifically for BIPOC (Black, Indigenous, or People of Color) entrepreneurs. Although the BIPOC Loan Fund ($500 – $10,000) is more competitive, it also has less formal requirements that can help BIPOC business owners qualify for a loan.

Which Loan would you like to apply for?(Required)

Apply for the BIPOC Loan Fund

Apply for a CIC Microloan

I am not sure, I would like more information.

Click here to learn more about the BIPOC Loan Fund.

Click here to learn more about CIC’s traditional business loans, such as the microloan and standard loan.

Based on your answers and requested loan size, CIC’s Standard Loan would be the best fit for your business. Click Next if you are interested in answering some more questions and providing us your information, which will allow us to set up a phone call with you.

Interested in the BIPOC Loan Fund?

If you would rather apply to the BIPOC Loan Fund, please change your loan size to $10,000 or less.

Because you are interested in multiple services with CIC, this page might ask you questions about each service you selected.

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Not a Good Fit – Page 2

Unfortunately, it doesn’t appear CIC will be able to meet your needs for the following reason(s):

• Your requested loan size is too large — We typically make loans up to $100,000.

• Your business is located outside of our service area. If you are located outside of Southern Arizona, we suggest reaching out to Arizona Capital Source, Growth Partners Arizona, or visiting AZNavigator to find a provider in your county.

• Loan applications typically take at least 4 weeks to process. If you do not have at least 4 weeks CIC is not the right fit. If you have more than 4 weeks, please return to the previous page and select the 1 – 2 months option.

If your circumstances change, please feel free to come back and complete a new form to determine if CIC can be of any assistance. Thank you!

*Please note: if you are eligible for other services with CIC, you will see additional questions on this page. You can continue the form if you are still interested in those services.

Still interested in staying in touch? Please click here to sign up for CIC’s newsletter and receive updates from our Lending team!

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BIPOC Loan Fund – Owner Demographics

List proprietors, partners, officers, directors, and all holders of outstanding stock. 100% of ownership must be shown. 50% ownership must identify as BIPOC to qualify for this program. Not applicable for nonprofits.

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Owner Demographics(Required)

To add additional owner information, click the + button to the right.

Owner Name

Owner Cultural Identity

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BIPOC Loan Fund – Business Information

BIPOC Loan Fund – Begin Application

Based on your responses, you have selected to apply for the BIPOC Loan Fund, which approves loans of less than $10k on a rolling basis.

Please answer the questions below to make sure you are a good fit for the BIPOC Loan Fund. On the next page, you will be asked to provide your contact information.

Click here to learn more about the BIPOC Loan Fund.

BIPOC Loan Fund – Business Information

Business website and Social Media handles(Required)

If you do not have any, enter “N/A”

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BIPOC Loan Fund – Staffing

Number of Full-time employees(Required)

Include any full-time owners here. If none, enter 0.

Number of Part-time employees(Required)

Include any part-time owners here. If none, enter 0.

Number of Full-time contractors(Required)

If none, enter 0.

Number of Part-time contractors(Required)

If none, enter 0.

Number of Full-time volunteers(Required)

If none, enter 0.

Number of Part-time volunteers(Required)

If none, enter 0.

Business Entity(Required)

Sole Propietorship

Limited Liability Company (LLC)

Corporation

Partnership

Nonprofit

Other

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BIPOC Loan Fund – Declarations

Responding yes or no to any of the below questions does not automatically disqualify you from this loan opportunity. Decisions will be made on a case-by-case basis.

Do all business owners file personal taxes?(Required)

Yes

Unsure

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Sub-Total for Do all business owners file personal taxes?

Please explain why owners do not file taxes:(Required)

Does the business file taxes?(Required)

Yes

Unsure

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Sub-Total for Number for Does the business file taxes?

Please explain why the business does not file taxes.(Required)

Does your business owe any taxes from prior years?(Required)

Yes

I am not sure

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Sub-Total for Does your business owe any taxes from prior years?

Does the owner(s) listed have an ownership stake or interest in any other business(es)?(Required)

Yes

Unsure

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Sub-Total for Does the owner(s) listed have an ownership stake or interest in any other business(es)?

Please describe/list any other businesses in which the owners are involved. Also, explain the nature of the involvement / ownership stake.(Required)

Example: Owner John Doe holds a 50% stake in XYZ company, a member-managed LLC.

Is the owner(s) listed above party to any judgments, suits, or litigation?(Required)

Yes

Unsure

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Sub-Total for Number for Is the owner(s) listed above party to any judgments, suits, or litigation?

Please explain:(Required)

Has the owner(s) listed above ever been convicted of a felony?(Required)

Yes

Unsure

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Sub-Total for Has the owner(s) listed above ever been convicted of a felony?

Please explain:(Required)

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Total for BIPOC Loan Fund – Declarations

Calculates all sub-totals in the “BIPOC Loan Fund – Declarations” Section.

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Small Business Loans with CIC

Based on your responses, you have chosen to inquire for a Microloan with CIC, which ranges from $500- $10,000.

Please answer the questions below to make sure you are a good fit for a Microloan. On the next page, you will be asked to provide your contact information.

Click here to learn more about Business Loans with CIC.

Small Business Loans with CIC

Based on your responses, you have chosen to inquire about a Standard Loan with CIC, which ranges from $10,000- $100,000.

Please answer the questions below to make sure you are a good fit for a Standard Loan. On the next page, you will be asked to provide your contact information.

Click here to learn more about Business Loans with CIC.

How long have you been in business?(Required)

Less than 6 months ago

6 – 24 months ago

More than 2 years ago

I have not officially established my business

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Sub-Total for How long have you been in business?

*We typically require businesses to be in operation for at least six months before we are able to make a loan. If you would like to discuss your loan need with us or learn more about what is needed for an application, please continue filling out this form.

*We are only able to make loans to established businesses but are happy to guide you through the steps that are needed to get you ready for a loan. If you would like help with the process, please continue completing this form.

Do you have a business bank account?(Required)

Business bank accounts are specifically for transactions associated with a registered business. They are different from a personal banking account.

Yes

Unsure

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Sub-Total for Do you have a business bank account?

*As part of the loan application process, you will be required to open a business bank account. We are happy to help you with the process or provide you with referrals to local banks if you are not sure where to go.

Do you prepare business financials? Please check all that apply.(Required)

Balance Sheet

Income Statement

Cash Flow

I am not sure OR I do not prepare financials

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Sub-Total for Do you prepare business financials?

*You will need to provide business financials as a part of the loan application. Please visit our Business Financials page to obtain templates or to learn how to prepare your financials. If you would prefer 1:1 guidance in preparing your financials, please let our staff know and we would be happy to help.

In the last 12 months (or most recent fiscal year)…(Required)

My business generated a profit

My business broke even

My business took a loss

I’m not sure if my business was profitable or not

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Sub-Total for In the last 12 months (or most recent fiscal year)…

*Businesses typically need to be profitable in order to qualify for a loan. If you would like help in determining your profitability or would like to discuss your options, please continue filing out this form.

Do you file business taxes?(Required)

Business taxes can be filed separately from the owners’ income tax returns, or in some cases, may be part of their personal return.

Yes, and I can provide them for each year I’ve been in business.

Yes, but I would have trouble providing them.

No, I do not.

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Sub-Total for Do you file business taxes?

*Businesses must be current on their tax fillings in order to obtain a loan. If you would like helping in determining if you are current or would like to discuss your options, please continue filing out this form.

Do all the business owners file personal taxes?(Required)

Yes, and I can provide the last 2 years’ worth.

Yes, but I would have trouble providing the last 2 years’ worth.

No, I do not.

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Sub-Total for Do all the business owners file personal taxes?

*Business owners must be current on their personal tax filings in order to obtain a loan. If you would like helping in determining if you are current or would like to discuss your options, please continue filing out this form.

Is your business registered with the state of Arizona?(Required)

Yes

Not sure

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Sub-Total for Is your business registered with the state of Arizona?

*The business must be registered with the state of Arizona in order to obtain a loan. We are happy to help you with the process or provide you with more resources if you are not sure where to go.

What is the minimum loan amount that would be useful to you?(Required)

CIC’s microloans and BIPOC loans max out at $10,000. CIC’s standard loans typically max out at $100,000.

Please enter a number from 0 to 100000.

What would you like to use the loan funds for?(Required)

Please check all that apply.

Purchase capital for business

Acquire new facility

Payroll, staffing, etc.

Purchase new technology

Pay off personal expenses

Pay off another loan

Large Construction Project

Other

Does your business have collateral for your loan?(Required)

Personal collateral can also be considered.

Yes

I am not sure

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Sub-Total for Does your business have collateral for your loan?

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Total for Small Business Loans with CIC

Calculates all sub-totals for fields in “Small Business Loans with CIC” section.

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Success Through Alternative Capital (STAC)

Thank you for your interest in STAC – our revenue-based financing initiative for small businesses. To learn more about revenue-based financing or to see if the program is a fit for your company, please complete the questions below.

Does your business have at least two years of revenue?(Required)

Yes

STAC requires a minimum of two years revenue. If you would like to learn more about the other products we offer that may be a fit for your company, please return to the start of this form by clicking “Previous” at the bottom of this page.

Is your business profitable?(Required)

Yes

I am not sure

What is your annual gross revenue?(Required)

Do you have a business bank account?(Required)

Yes

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Business Education with AZNavigator

Based on your responses, you have chosen to inquire about Business Education.

Please answer the questions below to make sure you are a good fit for Business Education/Support, which CIC offers in partnership with the AZNavigator Program.

Please note that the fields in this section are for reporting purposes only, as required by AZNavigator. Your responses will be kept private and secure. The information will not be used for any discriminatory purpose.

Click here to learn more about Business Education with CIC.

CIC offers the following services to small businesses in Arizona:

Business Technical Assistance: CIC offers one-on-one guidance to help small business owners gather their information and check every item needed for loan applications that are often complex and difficult to complete.
Business Counseling: CIC offers one-on-one mentoring to help your small business grow. Topics we can help with include preparing for a loan, access to capital, and scaling your business.
Financial Literacy: CIC offers workshops and coaching for topics like preparing business financials or learning how loans work.

Which service(s) are you requesting help with? (Mark all that apply)(Required)

Business Technical Assistance (Loan Application Assistance)

Business Counseling

Financial Literacy

Other

If you selected "Other," please explain:(Required)

Number of Years in Business(Required)

0 years – I am just starting a business

0-2 years

2+ years

Has your business previously participated in any of the following programs?(Required)

Payroll Protection Program (PPP) Loan

Economic Injury Disaster Loan (EIDL)

Tribal COVID-19 Small Business Programs

Other Small Business Administration (SBA) Loans or Programs

None of the above

Have you or your business been negatively impacted by the effects of the COVID-19 Pandemic?(Required)

Yes

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Demographic Information

Please note that the fields in this form are for reporting purposes only. Your responses will be kept private and secure. The information will not be used for a discriminatory purpose.

Age

Under 18 Years

18-24 Years

25-64 Years

65 Years and Older

Prefer not to answer

Gender

Female

Male

Non-Binary

Transgender

Prefer not to answer

Race and Ethnicity(Required)

Please check all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino

Multiracial

Native Hawaiian or Other Pacific Islander

Other

White

Prefer not to answer

Disability Status

Able-bodied

Not able-bodied

Prefer not to answer

Sexual Orientation

Lesbian

Gay

Bisexual

Heterosexual

Not Applicable

Other

Prefer not to answer

Sexuality (Other)(Required)

Veteran Status

Veteran

Veteran Spouse

Non-Veteran

Prefer not to answer

Almost there! Please click Next to provide us your contact info.

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Contact Information

Tell us more about yourself!

Please answer the questions below to get in touch with CIC. Note: If you would like to receive a link of your form to complete at a later time, please click “Save & Continue Later.”

Name(Required)

First Last

Title(Required)

Email(Required)

Enter Email Confirm Email

Do you have a business email address different from the one listed above?(Required)

Yes

Business Email(Required)

Would you like to sign up for CIC's newsletter?(Required)

Sure, I’ll give it a try!

No.

Which email address would you like to sign up with?(Required)

The first email address

The second email address (Business)

Both

Business Phone(Required)

Business Name(Required)

Ideally, please use the name that your business is registered under.

Please describe the nature of your business (1-2 sentences)(Required)

How did you hear about us?(Required)

Internet Search (Google)

A Friend/Family Member/Business Associate

Social Media

A Community Organization

Community Event

Flyer/Newsletter

Other

Other:(Required)

Which Community Organization referred you?

Startup Tucson

YWCA

Tucson Industrial Development Authority (IDA)

SBDC – Cochise College

SBDC – Eastern Arizona College

SBDC – Pima Community College

Startup Unidos

Arizona Capital Source

Nogales-Santa Cruz County Chamber of Commerce

Growth Partners of Arizona

American Southwest Credit Union

Other

Other Community Organization:(Required)

Please note: You will be sharing your business story with us in Step Two of your application. We ask that you save those details for Step Two.

Anything else you'd like us to know?

Thank you for providing your information. The last step in the BIPOC Loan Fund Application is to tell us your Business Story. More information will be emailed to you.

Click here to preview the questions you will answer in Step Two.

I understand my BIPOC Loan Fund application is not complete yet.(Required)

Once I submit this information to CIC, I will receive information on Step Two at the email address I provided above.

Step One AND Two must be completed in order to be considered for a BIPOC Loan.

Revenue-Based Financing Form

Lending Intake Form

Because you are interested in multiple services with CIC, this form will ask you questions about each service you selected.

Loan Inquiry Questions: Phase 1

Hey, just a quick note!

Loan Options

Interested in the BIPOC Loan Fund?

Because you are interested in multiple services with CIC, this page might ask you questions about each service you selected.

Not a Good Fit – Page 2

BIPOC Loan Fund – Owner Demographics

BIPOC Loan Fund – Owner Demographics

BIPOC Loan Fund – Business Information

BIPOC Loan Fund – Begin Application

BIPOC Loan Fund – Business Information

BIPOC Loan Fund – Staffing

BIPOC Loan Fund – Staffing

BIPOC Loan Fund – Declarations

BIPOC Loan Fund – Declarations

Small Business Loans with CIC

Small Business Loans with CIC

Small Business Loans with CIC

Success Through Alternative Capital (STAC)

Success Through Alternative Capital (STAC)

Business Education with AZNavigator

Business Education with AZNavigator

Demographic Information

Demographic Information

Almost there! Please click Next to provide us your contact info.

Contact Information

Tell us more about yourself!

Please note: You will be sharing your business story with us in Step Two of your application. We ask that you save those details for Step Two.

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