Customer Success Story Information Form Question Title * 1. What is your name? Question Title * 2. What is your company name? Question Title * 3. How much capital did you receive from Fora Financial? Question Title * 4. Please provide your email address? Question Title * 5. What industry is your company in? Question Title * 6. What were the opportunities/challenges requiring additional funding? Question Title * 7. How did the funds from Fora Financial help address your needs? Question Title * 8. What were the results realized by your company after using the funds? Question Title * 9. Why did you choose Fora Financial as your funding partner? Question Title * 10. Is there anything else you’d like to share about your experience with Fora Financial and/or how the funds received helped your business success? Question Title * 11. Would you be interested in a phone interview? Question Title * 12. Was this your first time receiving funds from Fora Financial? Yes No Question Title * 13. If you have received funding from Fora Financial previously, how many times? 1 2 3 4+ Done