Do not use this form to apply by mail. If you wish to make a mail application, you must phone or write the CMI office for information about how to apply. Applications using this form by mail will not be considered.

Practice Online Application Form
	Amount Requested	500 to 5000 dollars
	Loan Purpose - Choose Only One:	starting business inventory purchases paying off bills launching new product or service living expenses marketing and promotion rent buying building working capital
Owner (person applying)
	Email	You must have an Email address
	First Name
	Last Name
	Birthdate	You must be 18 or older
	Social Security Number	You must have a SS number, and be a US resident
	Gender
	Ethnicity - Choose Only One:	African American Native American Asian or Pacific Islander Hispanic Caucasian
	Marital Status
	Business Phone & Area Code	May be the same as your home phone
	Home Phone & Area Code
	Monthly Housing Payment	Rent or Mortgage
	Total Other Monthly Expenses
	Total Monthly Income	This is your total income from all sources.
Address
	Street Address	You must be a US resident
	City
	State
	Zip
	Months at Address
:	Residence type - Choose Only One:	own/buying live with parents/relative rent miscellaneous
Employer
	Occupation - Choose Only One:	Homemaker Childcare provider or worker Office worker Manufacturing worker Construction or Labor Business owner manager of small business corporate employee retired Sales and marketing Personal services -cleaning,hair stylists,etc. Business services - graphics, consulting Student unemployed with government assistance military Social worker or nonprofit employee Other
	Self Employed	Yes no
	Employer Name
	Employer Address
	Employer City
	Employer State
	Employer Zip
	Employer Phone
	Months Of Service
	Date You Started
	Monthly Income	Your personal income
Additional Information
	How many years making your product or service?
	How many years selling your product or service?
	6 month gross sales	Projected if a new business
	Do you have family who have their own small business?	Yes no
	Which family member?- Choose Only One:	Parent Sibling Spouse Other
	Do you have a written business plan?	Yes no
	Has someone read your plan?	Yes no
	Business class or workshop in the last 6 months?	Yes no
	If yes, describe the class	Detailed answer required
	Type of Business you own	Detailed answer required
	Prior Experience in this business	Detailed answer required
	Why did you start your business?	Detailed answer required
	Describe who your customers are	Detailed answer required
	How do you plan to spend the loan money	Detailed budget