NEW ECONOMY LOAN FUND INTAKE FORM

The New Economy Loan Fund makes low-cost, nonextractive loans to support worker cooperatives, community land trusts, community solar projects, and other democratically controlled initiatives that benefit and are led by low income and BIPOC communities in New York City. Read more at neweconomynyc.org/loanfund.

Please complete this intake form if you are interested in applying for a loan or learning more. A member of the loan fund team will follow up within a few business days to discuss next steps.

1. APPLICANT INFORMATION

First Name *

Last Name *

Organization/Business Name *

Organization/Business Address *

City *

State *

Zip Code *

Phone Number *

Email *

Preferred Method of Contact *

Phone

Mail

2. ORGANIZATION/BUSINESS DETAILS

Primary Contact *

Phone Number *

Type of Entity (e.g. Nonprofit, LLC) *

Date Established *

EIN/Tax ID Number *

Number of Employees (Full-Time or Part-Time) *

Briefly Describe your Organization/Business (including mission and services provided) *

Briefly Describe your Governance Structure *

Names and Titles of Owners/Key Management *

Neighborhood(s) or Populations Served *

3. LOAN REQUEST INFORMATION

Loan Amount Requested * $

Purpose of Loan/Use of Funds

Other Purpose

Preferred Loan Term: (e.g., 12 months, 3 years)

4. FINANCIAL INFORMATION FOR ORGANIZATION/BUSINESS

Annual Revenue - Please provide annual revenue for your most recent 3 years *

Net Income - Please provide net income for your most recent 3 years *

Current Assets * $

Current Liabilities * $

Debt Schedule: (List current debts and repayment terms) *

5. PROJECT DETAILS (IF APPLICABLE)

Project Name

Project Description

Project Location

Project Start Date

Project Completion Date

Total Project Cost $

Funds Raised/Committed $

Sources of Funding

6. ADDITIONAL INFORMATION

Are you currently working with an accountant or finance consultant? *

Have you applied for loans or funding elsewhere?

Yes (please provide details)

Other Loans or Funding

Any additional information or comments