Small Business Interest Form

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At LISC, we focus on bolstering entrepreneurs whose lack of access to capital and services reflects deep, longstanding structural inequities—businesses owned and operated by people of color, women, immigrants, and veterans, and those located in low-wealth, underserved places.

This interest form is for small businesses interested in financing from LISC Virginia. By completing this form, LISC Virginia staff will be better able to assist your business.

Your information will remain confidential and will not be shared with any partner organizations without your permission.

Upon completion of the interest form, staff from LISC Virginia will contact you with additional questions regarding your request.

Business Owner

1) First Name

2) Last Name

3) Email Address

4) Phone Number

Business Information

5) Legal Business Name

6) Doing Business As (DBA)

7) Street Address (physical location)

8) City/County

9) State

10) Website

11) What date did your business begin operations?

12) Including yourself, how many employees does your business currently employ?

13) What are your business's primary goods and services? What are your primary sources of revenue?

14) What is your business's primary industry?

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Assistance Requested

15) What type of support are you looking for your business? (select all that apply)

Working Capital LoanCommercial Real Estate Loan

16) If you are interested in a loan, how much funding are you looking for?

17) What will you use the loan funding for?

18) How will this loan help your business?

LISC Loan Document Checklist

If you wish to start a loan request with LISC, we will request the following documents after review of the interest form:

Personal Tax Returns (3 years)
Business Tax Returns (3 years)
Interim Financial Statements (profit and loss & balance sheet)
Personal Financial Statement
Business Debt Schedule
Lease Agreement
Contracts/Quotes for Leasehold Improvements/FFE

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