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11.06.2014
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Is your business still operating?
(required)
Yes - open and making a profit
Yes - losing money and barely hanging on
No - business closed and assets liquidated
Are you behind on payments to any creditor?
(required)
No
Yes - 30 days or more
Yes - 60 days or more
How much debt does your business have? *
(required)
under $50,000
$50,001-$100,000
$100,001-$200,000
$200,001-$500,000
$500,001-$1,000,000
$1,000,000+
Name
(required)
Email
(required)
Phone Number
(required)
This field should be left blank
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