Application – Disaster Loan Packaging

APPLICANT INFORMATION

Business Name

Trade Name (if different from legal name)

EIN

Organization Type

Gross Revenues for last 12 months

Cost of Goods sold for last 12 months

From

To

Primary business address:

City

State

Zip

County

Business Activity

Number of Employees
(pre-disaster)

Date Business Established

Current Ownership Since

Business phone

Business Email:

Have you applied online with SBA for the EIDL program?

Yes

No

SBA reference number

Did you receive the EIDL grant of up to $10,000 ($1000 per employee)?

Yes

No

How much?

OWNER 1:

First Name

Middle Name

Last Name

Title/Office

% Owned

Home Address

City

State

Zip

County

Cell Number

Email

SSN or EIN

Date of Birth

Place of Birth

Are you a U.S. Citizen?

Yes

No

OWNER 2

CO-BORROWER:

Schedule of liabilities (Notes, mortgages, accounts payable, automobiles....)

Type

Purpose

Name of Creditor

Original Amount

Original Date

Current Balance

Current/Delinquent

Maturity Date

Monthly Payment

How Secured

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