LISC LA Kiva Borrower Intake Form Survey

Kiva is an online loan crowdfunding platform that enables entrepreneurs to access 0% interest small business loans up to $15,000. LISC LA has a Kiva Accelerator Fund to match borrower campaigns $1 for $1. In order to receive the matching funds, businesses need to be endorsed by a LISC Kiva Trustee in LA County. Kiva’s model is unique because it uses social underwriting--a borrower’s character, relationships, and reputation--instead of their credit scores or assets to access business capital.

Please complete the intake form to start the process and be eligible for the Kiva Accelerator Fund match.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Business Name

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* 5. Business Address

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* 6. Business City/Town

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* 7. Business State

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* 8. Business Zip Code

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* 9. Website

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* 10. Primary Social Media Address (e.g. Facebook, Twitter, or Instagram)

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* 11. Years in Operation

Less than 1 year

1-2 years

3-5 years

6-9 years

10 years or more

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* 12. What was your business’s gross revenue in the calendar year 2019 (1/1/2019 to 12/31/2019)?

Less than $50,000

$50,001 to $99,999

$100,000 to $299,999

$300,000 to $499,999

$500,000 to $999,999

$1,000,000 to $4,999,999

$5,000,000 or higher

My organization did not have positive revenue in calendar year 2019

My organization did not exist in the calendar year 2019

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* 13. What was your business’s gross revenue in the calendar year 2020 (1/1/2020 to 12/31/2020)?

Less than $50,000

$50,001 to $99,999

$100,000 to $299,999

$300,000 to $499,999

$500,000 to $999,999

$1,000,000 to $4,999,999

$5,000,000 or higher

My organization did not have positive revenue in calendar year 2020

My organization did not exist in the calendar year 2020

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* 14. Do you have a business license?

Yes

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* 15. Business Industry

Accommodation and Food Services (includes hotels, restaurants, bars, mobile food vendors, etc.)

Administrative and Support and Waste Management and Remediation Services (includes establishments performing routine support activities for the day-to-day operations of other organizations, includes employment services, business support services, travel and reservation services, services to buildings and dwellings)

Agriculture, Forestry, Fishing and Hunting (includes farms, ranches, dairies, greenhouses, nurseries, orchards, or hatcheries)

Arts, Entertainment, and Recreation (includes theater, dance and music companies, museums, sports teams, performing artists, fitness and recreation centers, etc.)

Construction (includes general contractors, trade contractors such as painting, masonry, plumbing, electrical work, etc.)

Educational Services(includes elementary and secondary school, technical, skills and trade training, language schools, sports and recreation instruction, etc.)

Finance and Insurance (includes banks, credit unions, savings institutions, non-depository credit institutions, insurance agencies, etc.)

Health Care & Social Assistance (includes office of physicians and dentists, family planning centers, nursing care, child and youth services, child day care services)

Information (includes newspaper and periodical publishers, film producers, music and radio producers, etc.)

Management of Companies and Enterprises (includes establishments that administer, oversee, and manage may hold the securities of the company or enterprise)

Manufacturing (includes factories, makers, bakeries, candy makers, custom tailors, etc.) _Mining, Quarrying and Oil and Gas Extraction (includes establishments that extract or beneficiate naturally occurring mineral solids)

Professional, Scientific and Technical Services, Scientific, and Technical Services (includes legal, accounting and tax services, architectural, engineering and design services, consulting, marketing services, veterinary services, etc.)

Real Estate and Rental and Leasing (includes property management, asset management and leasing)

Retail Trade (includes food stores, groceries and convenience stores, hardware stores, nurseries/garden centers, flower shops, bookstores, car dealers, apparel stores, etc.)

Transportation and Warehousing (includes providing transportation of passengers and cargo, warehousing and storage for goods, scenic and sightseeing transportation)

Utilities (includes provision of electric power, natural gas, steam supply, water supply, and sewage removal)

Wholesale Trade (includes wholesaler merchants and distributors)

Other Services (includes repair and maintenance services, personal care services like nail and hair salons, spas, barbershops, dry cleaning and laundry services, general automotive repair, etc.)

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* 16. Gender

Woman

Man

Non-Binary

Other

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* 17. Veteran

Yes

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* 18. Race/Ethnicity

African American/Black

American Indian/Alaska Native

Asian

Native Hawaiian/Pacific Islander

Hispanic/Latino

White

Biracial

Multiracial

Other

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* 19. How did you hear about the LISC LA Kiva Program?

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* 20. Have you worked with a Kiva Trustee?

Yes

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* 21. What size loan are you interested in for your business? Note: The maximum Kiva loan size is $15,000

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* 22. How will you use the Kiva loan for your business?

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* 23. LISC LA has a number of partners and programs to assist small businesses. Which of the following areas your business is interested in learning more about? Please check all that apply.

Micro-Loans

Financial Planning

Digital Marketing Assistance

Website and E-Commerce Support

Social Media Support

Legal Support

Strategic Business Planning

Purchasing my commercial space

Succession Planning

Other (please specify)