Capital Catalyst Venture Debt Application

Thank you for your interest in the Capital Catalyst Vendure Debt program. This application allows you to save your progress. It is recommended that you utilize this feature if you need additional time to complete the application. Click the "Save Progress" button and create a user login. Please be sure to keep a record of your username and password. When all information is complete please click the "Submit" button to submit your application.

BORROWER INFORMATION

Borrower Business Name

Tax ID #:

Trade Name or Doing Business As (d.b.a)

Street Address

Address Line 2

City

State

Zip Code

Contact Name

Title

Phone Number

Email Address

Legal Form of Entity

As an LLC, how is it managed:

If a corporation, is there preferred stock or more than one class of stock?

Yes

No

Date of organization/incorporation +

State of organization/incorporation

North American Industry Classification System (NAICS) Code
Click here for NAICS Search

Shareholders: (May be grouped as Angels Series A, Angels Series B, Friends/Family Investors, etc.)

	Name	Social Security #	Title	Ownership %
1	Name	Social Security #	Title	Ownership %
2	Name	Social Security #	Title	Ownership %
3	Name	Social Security #	Title	Ownership %
4	Name	Social Security #	Title	Ownership %

Percentage of the business owned by

	%
Minority	%
Woman	%
Veteran	%

Ownership Ethnicity

Did the present owners establish the business?

Yes

No

From whom and when was the business acquired?

Has the business ever changed its name or operated under any trade names?

Yes

No

Please list all trade names under which you do business:

How long has the current management operated the business?

Is there a written operating agreement or bylaws?

Yes

No

Limited Liability Company (LLC)	Corporation
S-Corporation	Sole Proprietor
Partnership	Other Other