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Date*
MM slash DD slash YYYY
PROJECT AND OWNER INFORMATION
Project Name*
Email Address-1*
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Email Address-2
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Project Physical Address*
Street Address Address Line 2 City State ZIP Code
Project Started*
- Yes
- No
Reason Needing Funding*
Project Type (Energy, Real Estate, etc)*
Total Project Assets (Today & Future)*
Capital Invested To Date*
Owners Name*
First Last
Owners Primary Phone Number*
Owners Alternate Phone Number
FINANCIAL INFORMATION
Liquid Capital Available Today*
Amount Of Funding Needed For Project!*
Type Of Investment Required*
- Loan/Debt
- Equity
- Both
Current Loans / Investment for Project*
Please enter a number greater than or equal to 2000000.00.
Total Time to Complete Project*
Launch Date*
When do you expect to begin construction.
Applicant's Signature*
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PROJECT AND OWNER INFORMATION