The information you provide is confidential and will only be shared with CRLF staff and the Peer Review Panel charged with reviewing your application for a community-supported micro-loan.
Before completing this application, please review all of the eligibility requirements and terms listed on our website: www.asntb.com/revolving-loan-fund.html
Did you review all of the eligibility requirements and loan terms listed on our website?

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* 1. Did you review all of the eligibility requirements and loan terms listed on our website?

First and last name:

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* 2. First and last name:

How long have you been a Time Banker?

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* 3. How long have you been a Time Banker?

Have you had at least 3 transactions in the last 6 months with 3 different people?

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* 4. Have you had at least 3 transactions in the last 6 months with 3 different people?

How has Time Banking affected your life?

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* 5. How has Time Banking affected your life?

How did you hear about the ASECO Community Revolving Loan Fund?

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* 6. How did you hear about the ASECO Community Revolving Loan Fund?

Email:

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* 7. Email:

Phone:

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* 8. Phone:

What is your gender?

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* 9. What is your gender?

Languages spoken (please indicate level of proficiency):

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* 10. Languages spoken (please indicate level of proficiency):

Please refer to the chart below for your family's income:

Household
Size ------ A ------ ---- B ----
1 ------- $11,490 --- $22,980
2 ------- $15,510 --- $31,020
3 ------- $19,530 --- $39,060
4 ------- $23,550 --- $47,100

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* 11. Please refer to the chart below for your family's income:

Household
Size ------ A ------ ---- B ----
1 ------- $11,490 --- $22,980
2 ------- $15,510 --- $31,020
3 ------- $19,530 --- $39,060
4 ------- $23,550 --- $47,100

Business name:

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* 12. Business name:

Website:

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* 13. Website:

Type of business conducted:

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* 14. Type of business conducted:

Please check one:

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* 15. Please check one:

Business model:

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* 16. Business model:

Number of employees (full and part time, excluding owner):

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* 17. Number of employees (full and part time, excluding owner):

Location:

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* 18. Location:

Demographic served (who are your customers?):

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* 19. Demographic served (who are your customers?):

Years in operation:

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* 20. Years in operation:

Years of experience in this field:

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* 21. Years of experience in this field:

Do you have a business license?

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* 22. Do you have a business license?

Do you have a written business plan?

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* 23. Do you have a written business plan?

Why have you started / do you want to start this venture?

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* 24. Why have you started / do you want to start this venture?

What assets have you already invested (whether financial, in-kind donations, sweat equity, etc.)?

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* 25. What assets have you already invested (whether financial, in-kind donations, sweat equity, etc.)?

What other income (start-up funds, investment, loans, etc.) do you have?

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* 26. What other income (start-up funds, investment, loans, etc.) do you have?

Have you done any competitive landscape analysis (i.e. assessed who your competitors are, what they do well or poorly, how you are unique and better than your competitors)?

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* 27. Have you done any competitive landscape analysis (i.e. assessed who your competitors are, what they do well or poorly, how you are unique and better than your competitors)?

Do you have a marketing plan?

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* 28. Do you have a marketing plan?

Do you have growth projections for the next 3 years of business?

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* 29. Do you have growth projections for the next 3 years of business?

Skills Needed (please select all that apply):

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* 30. Skills Needed (please select all that apply):

How much would you like to borrow from the Community Revolving Loan Fund ($500-$5,000) and what would the funds be used for?

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* 31. How much would you like to borrow from the Community Revolving Loan Fund ($500-$5,000) and what would the funds be used for?

Please briefly describe how the funds requested relate to your repayment strategy. For example, if you are requesting money for equipment, will that equipment directly impact your revenue stream? If the funds requested do not directly impact your repayment strategy, please describe how you plan to pay the funds back.

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* 32. Please briefly describe how the funds requested relate to your repayment strategy. For example, if you are requesting money for equipment, will that equipment directly impact your revenue stream? If the funds requested do not directly impact your repayment strategy, please describe how you plan to pay the funds back.

If approved, you will have a maximum of 36 months to repay the balance plus 6% interest. How much would you like or be able to pay back each month?

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* 33. If approved, you will have a maximum of 36 months to repay the balance plus 6% interest. How much would you like or be able to pay back each month?

Have you ever applied for a small business loan?

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* 34. Have you ever applied for a small business loan?

How does your business give back to the community and/or positively impact the Arroyo SECO Network of Time Banks community? Please describe how. (If you do not yet have a community investment plan, we can help you!)

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* 35. How does your business give back to the community and/or positively impact the Arroyo SECO Network of Time Banks community? Please describe how. (If you do not yet have a community investment plan, we can help you!)

Does your business support, participate in or promote the Sharing Economy?

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* 36. Does your business support, participate in or promote the Sharing Economy?

Does your business have a social mission?

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* 37. Does your business have a social mission?

Does your business promote environmental and/or community sustainability?

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* 38. Does your business promote environmental and/or community sustainability?

Have you tapped the social capital of the ASNTB community in your business thus far?

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* 39. Have you tapped the social capital of the ASNTB community in your business thus far?

CREDIT CHECKS:

ASECO CRLF reserves the right to perform a credit check on anyone approved for a community-supported micro-loan by the Peer Review Panel. We also offer it as a service to any applicant. Credit check findings are solely for the purpose of understanding your credit history and to further help you develop your financial literacy. A poor credit history does not disqualify your application.

Do you have concerns about your credit history?

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* 40. Do you have concerns about your credit history?

Would you like ASECO CRLF to run a credit check for you?

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* 41. Would you like ASECO CRLF to run a credit check for you?

ASNTB COMMUNITY CREDIT CHECKS:

This loan fund was made possible by the community. As a member of this community, we value your involvement, contributions and interactions with other members. We require that you supply between 1-3 MEMBER REFERENCES who can attest to your commitment to our community, integrity and follow-through.
Please provide member FULL NAME, a brief description of your RELATIONSHIP/INTERACTIONS, how long you've known each other and why you've chosen to include this member as a reference:

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* 42. Please provide member FULL NAME, a brief description of your RELATIONSHIP/INTERACTIONS, how long you've known each other and why you've chosen to include this member as a reference:

What do you hope to achieve (the overall, big picture) with our help, whether financially through a loan or developmentally through our mentorship program (the Local Economy Incubator)?

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* 43. What do you hope to achieve (the overall, big picture) with our help, whether financially through a loan or developmentally through our mentorship program (the Local Economy Incubator)?

Is there anything not covered on this application that you would like to know about the ASECO Community Revolving Loan Fund or that you would like us to know about you?

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* 44. Is there anything not covered on this application that you would like to know about the ASECO Community Revolving Loan Fund or that you would like us to know about you?

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