First Name

Last Name

Email

Phone Number

Business Name

Existing Client Yes No

Service Inquiry CD Rates Mortgage Loan USDA Business Loan SBA Loan (Over $350,000) SBA Loan (Under $350,000) Hemp Banking Services Cannabis Banking Services Referral Partner Programs Personal Banking Services Farm Banking Services Interest on Lawyers’ Trust Accounts

Business Type Retailer Cultivator Manufacturer Transporter Processor Laboratory Other

Inquiry

How Did You Hear About Us? Search Engine Existing Client Social Media Email Marketing Broker Association Financial Inst. Event Other

Please Explain:

Multi-State Operator Yes No

Licensed Cannabis Business Yes No

Primary Operating State

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