Step 1 of 4 25% Personal Information Tell us about yourself so we can get to know you a little better. Name* First Last Date of Birth* Gender*ManWomanOtherPrefer Not to AnswerPreferred Language*EnglishSpanishOtherIf other, please specifyHome Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Preferred Method of Contact*PhoneTextEmailBest Times to Contact You*Number of Children in Household*Number of Adults in Household*Employment Status*Full-TimePart-TimeSelf-EmployedUnemployedCurrent Number of Jobs* Your Business We want to help you grow your business, so tell us a little bit about it. Your Business We want to help you grow your business, so tell us a little bit about it. Business Name*Business Legal Structure*LLCSole ProprietorshipPartnershipS-CorporationC-CorporationOtherIf other, please specifyBusiness Ownership Percentage*Please enter a value less than or equal to 1.Please input this as a decimalBusiness Description*Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal Amount Invested*Years in Business or Industry*Monthly Business Sales*Monthly Business Expenses*Desired Loan Amount*Desired Monthly Payments*Use of Funds* Your Finances Monthly Wage Income*Monthly Income from Other Household Members*Monthly Income from Other Sources*Bank Accounts* Personal Checking Account Personal Savings Account Business Checking Account Business Savings Account No Bank Account Please check off all bank accounts you haveLiquid Assets* Your Housing Tell us a little bit about your housing situation. Do you Own or Rent your Home?*OwnRentOtherIf other housing arrangement, please specifyNumber of Months at Current Home*Monthly Housing Costs*Have you had a 30 day Late Housing Payment in the Last 12 Months?*YesNoIf you have a late payment, please explainAdditional Comments to Support your ApplicationSocial Security NumberPlease leave this blank if you would prefer to give this to a loan officer over the phone.Today's Date* Agreement to HMFI's privacy policy* I agree This privacy policy discloses the privacy practices for the Hilltop Microfinance Initiative (HMFI). This privacy policy applies to information collected by our web site and our representatives. It will notify you of the following: What personally identifiable information is collected from you, how it is used and with whom it may be shared. What choices are available to you regarding the use of your data. The security procedures in place to protect the misuse of your information. How you can correct any inaccuracies in the information. Information Collection, Use, and Sharing We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via phone or other direct contact from you. We will not sell or rent this information to anyone. For our small business loan service, we collect non- public personal information (NPI) from our Small Business Loan Application. Information collected on this application includes name, address, phone number, and social security number. We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request, e.g. contact a reference. Unless you ask us not to, we may contact you via email in the future to tell you about new products or services, or changes to this privacy policy. Your Access to and Control Over Information You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website: See what data we have about you, if any. Change/correct any data we have about you. Have us delete any data we have about you. Express any concern you have about our use of your data. Security We take precautions to protect your information. When you submit sensitive information via the website or to a representative, your information is protected both online and offline. Wherever we collect sensitive information (such as personally identifiable information), that information is encrypted and transmitted to us in a secure way. We use Podio to handle client information because it encrypts and protects sensitive information. You can verify this by looking for a closed lock icon at the bottom of your web browser, or looking for “https” at the beginning of the address of the web page. Access to our podio.com virtual workspace is only granted to current employees. While we use encryption to protect sensitive information transmitted online, we also protect your information offline. All of our organizational documents are stored using Box. This file sharing service stores the organization’s data in a secure environment, and is only accessible by current employees. Updates Our Privacy Policy may change from time to time and all updates will be made available to current clients. If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at (202)505-4634 or via email at info@hilltopmfi.org. Share this content:
