*1.What is your name?(Required.)

*2.What is your company name?(Required.)

*3.How much capital did you receive from Fora Financial?(Required.)

*4.Please provide your email address?(Required.)

*5.What industry is your company in?(Required.)

6.What were the opportunities/challenges requiring additional funding?

*7.How did the funds from Fora Financial help address your needs?(Required.)

8.What were the results realized by your company after using the funds?

*9.Why did you choose Fora Financial as your funding partner?(Required.)

10.Is there anything else you’d like to share about your experience with Fora Financial and/or how the funds received helped your business success?

11.Would you be interested in a phone interview?

*12.Was this your first time receiving funds from Fora Financial?(Required.)

Yes

No

13.If you have received funding from Fora Financial previously, how many times?

1

2

3

4+