Please enter the following information: Full Name: Company: Address: City: State: Zipcode: Home Phone: Mobile Phone: Fax Number: Email: Membership Status: Choose One New Member Renewing Member New Member Sponsor, if applicable: Members must be from the following groups. Please choose one of the categories that applies to you: Choose One Government: Federal State County Munipical/Local Other Financial Institution: National State FDIC-Insured Credit Union Other Community: Community Development CDFI/CDE Church Economic Development Other Business: Hospitality Personal Services Professional Services Retail Real Estate Developer Transportation Business Broker Other Member group other: Select the number of full-time employees (30+ hours) in Prince George's County, if applicable. Choose One 0-10 10-30 30-50 50 or more Select your organization's size by sales revenue or budget range. Choose One $0K - 249K $250K - 499K $500K - 1.0M $1.0M - 4.9M $5.0M - 9.9M $10M - 19.9M $20M - 29.9M $30M - 49.9M $50M - 99.9M $100M or more Choose all that apply that describes your involvement in economic development in Prince George's County: Strategic partner SBA lender Community outreach Working capital financing Real estate financing Education Creating jobs Value-added services Other Involvement in economic development other: Choose all that apply that describes your interests regarding financing in Prince George's County? Value-added services (i.e., Attorney, CPA, Architect, etc.) Expand lending options Joint marketing strategies Attract small and minority businesses Access to local, state, and federal financing and business resources Professional management of loan application process Other Interests in financing other:

Thanks for your time and interest in completing the application as a new or renewing member of the Prince George's Financial Services Corporation. We value you.