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Company Name:

Chamber of Commerce number:

Initials:

Last name:

Postcode house number:

Email:

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Within how many months do you need financing?:

For what amount are you looking for financing?:

What is the main purpose of your financing?:

Explain your financing needs in 1 to 2 sentences:

Do you have an average turnover of at least EUR 10,000 per month over the past 6 months?:

How much turnover does your company expect to make in the next 12 months?:

If your required requested amount is less than 10% of your annual turnover:

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