Banking on Women Application Form

ABOUT YOU

Which Banking on Women Class would you prefer to attend?* Southern Utah Salt Lake

Name*

Date

Home Address*

Zip code*

Home Phone*

Mobile Phone

Work Phone

Email*

How did you hear about this program?

Why do you want to be a business owner?*

Given your understanding of the Banking on Women^TM program, why do you think you would make a good participant? What is your primary motivation for applying? Please explain any experience or background that you think makes you a strong candidate for the Banking on Women^TM program. (Note: 1500 character limit)*

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ABOUT YOUR BUSINESS

Please answer all questions to the best of your abilities, keeping in mind that you may not yet have the full answer to each question. All of the information you provide will remain confidential.

What is the state of your business?* Pre-business - I know what I want to do, but haven't started yet New - It's been selling for less than 1 year Existing, (been selling for more than 1 year)

Please list any goals you hope to reach in the next 12 months:

Please describe the kind of business you have or want to start (Note: 1500 character limit)*

Website

Last Grade Completed

Have you had previous business development training?* Yes No

Do you have formal training/experience in the field?* Yes No

Do you have a person or resource to turn to for advice and support?* Yes No

How would you envision a mentor helping you with your business plans?*

A unique component of this program is that mentors will be provided from Synchrony Bank to work with you during the Banking on Women course. While they may not have expertise in your particular business, they will be able to provide feedback, be a sounding board and an overall supporter.

Will/is your business home-based?* Yes No

I have a location for my business* Yes No

Will you OR do you employ other people?* Yes No

Describe the product and/or service you intend to sell*

Who do you see as your market?*

How do you intent on communicating/advertising to potential customers?*

Who are your competitors?*

Why would your customers buy from you vs. the competition?*

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YOUR FINANCES

We'd like to get a feel for your personal financial situation and how your business does or will impact it.

What are your sources of household income on a monthly basis?

Your current personal monthly income (if employed)

$

Your current personal monthly income from the business (if existing)

$

Spouse/partner monthly income (current)

$

Other monthly income sources*

$

Total Monthly Income

$

Total Annual Household Income

$

If you are presently employed, will you remain employed while starting/operating your business?* Yes No

What is your total household size?*

Do you rent or own?* Yes No

Are you a U.S. citizen or do you have a green card or other documentation that allows you to work in the U.S.?* Yes No

Are you current on all business and personal taxes?* Yes No

Have you ever filed bankruptcy?* Yes No

Will you (or have you) be putting any of your own money into this venture?* Yes No

Would you consider borrowing money to get your business started or grow it?* Yes No

If you were to request a loan, what would you be able to offer to secure the loan (collateral)?*

How is your credit history?* Excellent Good Fair Poor

If you don't know, go to Annualcreditreport.com for a free report.

List the income that will remain in place once the business has been started

Total Monthly Household Income*

$

Total Monthly Household Expenses*

$

NET monthly Personal Cash flow (income minus expenses)*

$

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PERSONAL BALANCE

Please estimate the value of what you own.

Cash in Banks*

$

Real Estate (primary residence)

$

Automobiles*

$

Retirement Accounts

$

Other monthly income sources

$

Total Assets*

$

Please estimate the total amount that you owe.

Total Mortgage Balance

$

Total Auto Loan Balance

$

Total Credit Card Balance

$

Total Student Loan Balance

$

Other Liabilities

$

Total Liabilities

$

Net Worth (Assets minus Liabilities)

$

By checking this box, I hereby acknowledge that I have read this entire application as completed, and that each response is true and complete to the best of my knowledge and accurately reflects my intended response.*

“Synchrony Bank's Banking on Women^TM is a business training course offered through community partners, is funded by grants from Synchrony Bank, and offers Synchrony Bank mentor opportunities. Typically the number of applicants exceeds the available space for any one session of the course, and by submitting this application you authorize the use of this information by the program administrators in a candidate selection process. This information is confidential and will not be used for any other purpose. We encourage you to apply again if not selected for the coming session. Should you have interest in a small business loan, whether selected as a candidate for the training course at this time or not, the loan application must be processed directly with a nonprofit microloan provider. Thank you for applying for Synchrony Bank's Banking on Women^TM program.”

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Banking on Women^TM Application

SUBMIT THE FORM BELOW TO APPLY FOR THE PROGRAM.
ALL FIELDS MARKED WITH AN ASTERISK (*) ARE REQUIRED.

ABOUT YOU

ABOUT YOUR BUSINESS

YOUR FINANCES

PERSONAL BALANCE

Credit Cards

Pay Later

Large retailers

Small business

Banking on WomenTM Application

SUBMIT THE FORM BELOW TO APPLY FOR THE PROGRAM.ALL FIELDS MARKED WITH AN ASTERISK (*) ARE REQUIRED.

ABOUT YOU

ABOUT YOUR BUSINESS

YOUR FINANCES

PERSONAL BALANCE

Banking on Women^TM Application

SUBMIT THE FORM BELOW TO APPLY FOR THE PROGRAM.
ALL FIELDS MARKED WITH AN ASTERISK (*) ARE REQUIRED.