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Type of Organization

For-Profit Business

For-Profit Impact Business

Nonprofit

Non-Profit Social Enterprise

Other

Business Headquarters

Number of Full-Time Employees

0

1

2 - 10

11 - 20

21 - 50

51 - 100

101 - 250

251 - 500

501 +

Amount of Cash Needed in Next 3 Months

None

Less than $10,000 (US)

$10,001 - $25,000

$25,001 - $50,000

$50,001 - $75,000

$75,001 - $100,000

$100,001 - $250,000

$250,001 +

Email address

First Name

Last Name

Organization

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