Name of Business or Nonprofit Organization Click to add (?) Contact First Name Click to add (?) Contact Last Name Click to add (?) Email Address Click to add (?) Phone Number Click to add (?) City business is located in Click to add (?) Business or Organization State -- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY Did you receive a prior PPP loan? Yes, I received a PPP loan from Self-HelpYes, I received a PPP loan from another lenderNo Can you show a 25% decrease in revenue as a result of COVID-19? YesNoI'm not sure Is your organization a business or a nonprofit? BusinessNonprofit What is your existing relationship with Self-Help? (Check all that apply.) I am an SHCU or SHFCU credit union depositor or member (includes our newly merged Lower Valley CU members).I am a current commercial borrower with Self-Help.I am a former commercial borrower with Self-Help.I am a commercial tenant of Self-Help.I am a vendor or contractor that does business with Self-Help.Other If "Other" please explain. Click to add (?) If a business: Is your business a certified MWBE (Minority-owned and/or Women-owned Business Enterprise)? Business is a certified Minority-Owned Business Enterprise.Business is minority-owned but is not certified.Business is a certified Woman-Owned Business Enterprise.Business is woman-owned but is not certifiedNo, business is not MWBE.N/A—organization is a nonprofit.Not Sure If a nonprofit: is your nonprofit led by a Person or People of Color or a women/women? (Check all that apply.) Led by a Person of Color or People of ColorLed by a woman or womenNot led by a woman/women or Person/People of color If a nonprofit, does your work serve primarily low income communities and communities of color? YesNoNot Sure Would you like to receive PPP Loan program updates from us? YesNo Would you like to receive general communications and news from us? (Frequency is roughly once a month.) YesNo Generate New Image Type the code from the image