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Connectivity Capital Borrower Information Sheet

Expanding Access to Connectivity with ISPs and MNOs

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Loan Inquiry Form

Name*

Email*

Company*

Location*

Approx. loan amount requested (in US Dollars $)*

Please describe your operating experience and track record*

Are you a member of an ISP Association or IXP (Internet Exchange Point)? (If so, please list all associations)

Do you have audited financials available?

How did you hear about us? *

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