Request an Application by Mail

Request an Application Package

Thank you for your interest in applying for a Self-Help small business or nonprofit loan. You can download applications or complete the form below and we will mail you an application package.

You can also Download an Application from our site.

Please Note: Red squares indicate required fields.

First Name (Required)

Last Name (Required)

Address (Required)

Address 2

City (Required)

State (Required)

Zip Code (Required)

Closest Self-Help Office (Required)

Central NC Region (Durham)
Triad NC Region (Greensboro)
Western NC Region (Asheville)
Charlotte NC Region (Charlotte)
Sandhills NC Region (Fayetteville)
Southeast NC Region (Wilmington)
Northeast NC Region (Greenville)
Washington DC (includes MD & VA)

Phone

Your E-Mail Address (Required)

Amount of funding requested

Purpose of Loan

Where did you hear about us?

Which application package do you need?

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