OIPA Pre-Application FIRST CLICK HERE TO VERIFY YOUR BUSINESS OR PROJECT IS IN THE OIPA BOUNDARY Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Business Legal Name and DBA *Business Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeInclude street, apartment or suite (123 Main St, Suite 100)Did you verify that your business is located with the Omaha Inland Port Authority Boundary? *— Select Choice —YesNoUse the link at the top of the page to verify by address.Business Phone Number *Business Email *Business NAICS CodeBusiness Annual Gross Revenue *Number of Full Time Employees *Number of Part Time Employees *Applicant Name *FirstLastApplicant Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeApplicant Email *Cell Phone Number (no dashes/spaces) *Do we have your permission to text and/or you with updates? *— Select Choice —YesNoHow did you hear about Omaha Inland Port Authority? *— Select Choice —TrainingCommunity PartnerReferred by existing or former clientSocial MediaStaff MemberApplicant/Owner Percentage of Ownership *Are you an emerging developer? *— Select Choice —YesNoApplicant/Owner Gender *— Select Choice —MaleFemalePrefer not to answerApplicant/Owner Ethnicity *— Select Choice —HispanicNon-HispanicApplicant/Owner *American Indian or Alaska NativeAsianBlack or African AmericanHispanic, Latino, or SpanishMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderWhitePlease check all that applyWhat type of financing are you looking for? *Loan Funds (requests up to $100,000)Grant Funds (requests under $25,000)Financing for Housing Development ProjectWhat services are you looking for? *Business Plan AssistanceTraining (QuickBooks, Marketing, Technical Assistance)MentorshipCredit Building ServicesHousing Development Technical AssistanceNoneBriefly Describe your need for financing: *If Housing Development Project please describe the # of units, and type of housing being created *Do you Agree to Complete a Prequalification Soft Credit Pull? (Submitting this will NOT impact your credit score) *— Select Choice —YesnoSubmitting this form will NOT impact your credit score. I hereby authorize Omaha Inland Port Authority to access my credit report on the date below for purposes of providing me with financial counseling and for inclusion in depersonalized/anonymized data within Member Outcome Reporting used to track aggregate consumer financial progress. I understand that this inquiry into my credit constitutes a “soft inquiry” and will not adversely affect my credit or credit rating. While this credit report and score pulled by Omaha Inland Port Authority on my behalf will be used to provide me with financial counseling, it is understood that I will not receive a copy of this credit report. Notwithstanding the foregoing, I understand that I have the right to dispute information with the credit bureau, to request reinvestigation, and to have corrected reports reissued to previous recipients of this credit report, if warranted. I understand that credit information is sensitive and that there may be inherent risks to accessing such data; I have had the opportunity to ask the Omaha Inland Port Authority staff any questions regarding such risks. I further understand that all my personal information will be held confidential by Omaha Inland Port Authority.Applicant Birthday *Social Security Number *Please enter your SSN with in NO dashes. Signature (Use your finger or mouse to sign below) * Clear Signature By signing above, I am requesting business assistance in the form of grants, a micro-loan, training, and/or business technical assistance or counseling from the Omaha Inland Port Authority or one or more of its program partners. I agree to participate should I or my business be selected to participate in follow-up surveys designed to evaluate OIPA or its partner services. I understand that any information disclosed will be held in strict confidence by OIPA staff, the OIPA loan committee and by any OIPA resource partner. In consideration of the counselor(s) working for OIPA or its partners furnishing management or technical assistance, I waive all claims against OIPA personnel, and that of its resource partners and host organizations, arising from this assistance. Meeting these criteria makes a business eligible to apply, not guaranteed to receive funds.Submit