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APPLICANT NAME:
__________________________________________________
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ADDRESS: _______________________________________________
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HOME
PHONE: _______________________________________________
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WORK
PHONE: _______________________________________________
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CELL
PHONE: _______________________________________________
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EMAIL: _______________________________________________
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BUSINESS NAME:
___________________________________________________
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TYPE: ________________________________________________
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ADRRESS: ________________________________________________
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PROJECT ADDRESS: ______________________________________________
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FINANCIAL INSTITUTION:
_______________________________________________
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CONTACT NAME: _________________________________________________
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CONTACT
PHONE: ________________________________________________
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1. Does the applicant own the project
building? ___ Yes ___ No
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If not, please provide building
owner’s name and address:
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_______________________________________________________________
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The HCSBRLF Board
reserves the right to request written permission from the building owner prior
to construction proceeding.
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2. Please describe the project. Attach
additional sheets if needed.
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3. Estimate of total cost:
____________________________________________________
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Please attach
a detailed project budget or equivalent financial document and business plan if
available.
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4. Amount of funding requested:
______________________________________________
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5. Approximate timeframe for project:
__________________________________________
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Attach
schedule if necessary
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I have read the Hancock county Small
Business Revolving Loan Fund Guidelines, and , believing I qualify submit this
application in good faith on behalf of the above listed business. I certify
that I have authority to enter into contracts on behalf of the business at the
business address listed.
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The HCSBRLF is authorized to make all
inquiries deemed necessary to verify the accuracy of the statements made herein,
and to determine my/our credit worthiness. The HCSBRLF is authorized to answer
questions about any credit experience with the applicant. The undersigned
acknowledges receipt of a copy of this instrument.
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APPLICANT SIGNATURE:
_________________________________________________
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APPLICANT PRINTED NAME:
______________________________________________
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DATE:
__________________________________________
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Application Check List:
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o
Original signed application
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o
One copy of application
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o
Completed Personal Financial Statement
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o
Project budget or equivalent financial
document
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o
Signed ACH form
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o
Business plan if available
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o
Project schedule if necessary
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o
Letter of reference from your financial
institution
