Business Development and Support Division

Company Name*

Title of person acting on behalf of this business (e.g. CEO, President)*

Name

First Last

Company Contact Information

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone*

Email*

Fax (if any)

Website (if any)

Your website address must contain the initial “https://” to be valid.

The Company Name listed above is a business and is registered to do business in the State of Hawaii and is in good standing*

Yes
No

The Company Name listed above is current on all County, State, and Federal Tax Filings and Tax Payments.*

Yes
No

Do you have financial statements (income statement and balance sheet) for two most recent fiscal years?*

Yes
No

Business Information

Date Established*

Type of Entity*

Sole Proprietorship
Partnership / LLP
Limited Liability Company
C-Corporation
Joint Venture
S-Corporation

Is business a for-profit business?*

Yes
No

Type of Business

Please describe your business*

Annual Revenue*

Number of Employees*

Loan Information

What loan amount are you seeking?*

Have you had one turndown from a commercial lender in the past year?*

Yes
No

What is the loan to be used for?*

Start-up costs
Working capital
Purchase, construction, or improvement of facilities
Purchase of equipment
Payment of production and marketing expenses including materials, labor, and services

What type of collateral do you have to secure a loan?*

Terms & Conditions*

I Agree

This form is for informational purposes only. By checking this box, you acknowledge that you have read and agree to allow the Hawaii Department of Business Economic Development and Tourism (DBEDT) to share this information with the Hawaii Department of Agriculture (HDOA) and the Hawaii Small Business Development Center (SBDC) for the purposes of co-lending opportunities with HDOA and for providing feedback on whether company is advised to submit full CBED loan application

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Business Development and Support Division

CBED Loan Interest Form

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