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New Hampshire Business Resource Center


Citizens Job Bank Pre-qualification Form

Thank you for your interest in the Citizens Job Bank program.

Answer a few quick questions, click submit, and we'll contact you shortly.

The information you submit will remain confidential and will only be reviewed
by the NH Business Resource Center and Citizens Bank.
Boxes highlighted in red are required fields necessary to process your form.

1. Contact Information:
  Salutation:
  First Name:
  Last Name:
  Title:
  Company:
  Address:
   
  City:
  State: Zip:
  Phone (XXX)XXX-XXXX:
  Fax (XXX)XXX-XXXX:
  Website:
  Email:

2. Company Classification:
  Industry:
  County:
  Company Description:

3. Operating Profile:
  Date of Establishment:
  Current Jobs (#):
  Annual Revenue
($):
  Projected New Jobs in NH:
  Loan Amount Request ($):
  Anticipated Use of Loan Proceeds:

For questions, please call (603) 271-2591.