NAC Affiliate Lead Submission | North Avenue Capital

Borrowing Company Name

Borrower Name

First Last

Borrower Title

(e.g., President)

Borrower Phone Number

Borrower Email Address

What is your relationship with the borrower?

Loan Amount Needed (Minimum is $1,000,000)

Provide the loan amount requested by the borrower.

Project or Property Address

Street Address Address Line 2 City State ZIP Code

Enter the address for the property where the funds will be invested.

Have you confirmed this is an eligible address?

Prior to submitting, please confirm the address at: https://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do?pageAction=rbs

Brief Project Summary

Please include: nature of the company (start up, early stage, legacy business, etc); what they do (industry, type of business, product/service, etc).

Use of Proceeds

Check all that apply

Financial Summary

Please include revenue and EBITDA figures (prior 3 years if known. Provide pro forma is pre-revenue)

Collateral Summary

Description of available collateral and appraisal/value estimates if known

Your Email (not the lead or borrower)