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Contact Information
First Name
*
Last Name
*
Email
*
Phone Number
*
Financing Information
Financing Term
*
Select financing term
1 to 3 years
4 to 5 years
6 years or more
Collateral Available
*
Machinery & Equipment
Commercial Real Estate
Residential Real Estate
Accounts Receivable
Inventory
Contracts & agreements
Other
Purpose of Financing
*
Select purpose of financing
Working capital
Growth/expansion
Management buyout
Purchase of equipment
Purchase of real estate
Debt refinancing
Discounted Pay-off (DPO)
Debtor-in-possesion (DIP)
Business acquisition
Recapitalization
Other
Upload a presentation or business plan
Upload File Here: https://benchmarqcapital.sharefile.com/r-rcffd3d7bc5254514a40772abd22715ad
Financing amount
*
Select financing amount
$100,000-$500,000
$500,001-$1,000,000
$1,000,001-$5,000,000
$5,000,001-$10,000,000
$10,000,001-$15,000,000
$15,000,001-$20,000,000
$20,000,001 or more
Please explain your financing needs
*
Business Information
Company Name
*
Years of Operations
*
Company Website
*
Industry
*
Select industry
Agriculture
Commercial real estate
Construction
Education
Energy
Entertainment
Finance & Insurance
Food & Beverage
Healthcare
Logistics
Manufacturing
Multi-family real estate
Retail trade
Services
Technology
Telecommunications
Tourism/Hospitality
Wholesale trade
Other
State
*
Select state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
US Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Number of employees
*
Select range
1-10 employees
11-25 employees
26-50 employees
51-100 employees
101-500 employees
501 or more employees
City
*
Annual revenues
*
Select range
$50,000-$150,000
$150,001-$300,000
$300,001-$1,500,000
$1,500,001-$5,000,000
$5,000,001-$6,500,000
$5,000,001-$6,500,000
$10,000,001 or more
Zip code
*
Annual net income
*
Select range
$0-$25,000
$25,001-$50,000
$50,001-$250,000
$250,001-$750,000
$750,001-$1,000,000
$1,000,001-$1,500,000
$1,500,001 or more
Other Information
Are you represented by a Broker or are you a Broker?
*
Yes
No
Thank you!
