BANKING QUESTIONNAIRE

Please complete one form for each company looking for banking.

How did you hear about us?*
Contact Information
First Name*
Last Name*
Title*
Phone*
Email*
Do you have authority to sign on behalf of the company (Yes/No)?*
Company Information
Company Name/DBA:*
Company Website:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Years in business:*
Number of locations:*
Number of employees:*
License Type (Temporary or Annual):*
- Cultivation
- Manufacturing
- Distribution
- Retail
- Lab
- Micro Business
Nature/purpose of business:*
Brands:*
Company Financials
Annual Revenue
Prior year:*
Year to date:*
Projected year end:*
Estimated amount of cash deposits per month:*
Do you currently accept payment other than cash? (credit card, debit card, etc.)*
Do you bank anywhere right now? If yes, where and for how long?*
Have you applied to any bank/credit unions? If yes, where and when did you apply?*
Additional Notes/Explanations:

Contact Information