CONTRA COSTA COUNTY
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
Small Business Loan Application
PERSONAL INFORMATION
Print Name _________________________________________ Home Telephone (___)__________ (last) (first) (middle)
Home Address _________________________________ ______________________ ___________
(street & no.) (city) (zip) Own ___ Rent___ How long? __ Yrs ___ Mos. Monthly rent or mortgage payments $__________ Social Security # ____-___-______ Married? ____ Single? ____ Separated?____ Divorced?_____
(documents if separated or divorced)
Children Residing in Household #__________
Spouse’s Name ____________________________ Annual Household Income $___________ Place of Birth ______________________________ U.S. Citizen ? ______yes ________ no
BUSINESS INFORMATION
Business Legal Name _______________________ Doing Business As __________________________ Business Address ________________________ ______________ Is this Your Home? ____________
(street & no.) (city & zip) (home occupancy permit?) Business License?______________ Is This a Commercially Zoned Location?________(permit required?) Business Telephone (___)__________ FAX (___)___________ E-mail Address ___________________ Monthly Rent? $_________ Lease Term? __________yrs Option to Extend? ______ years? ________ Organized as _______________________________________ (sole proprietor, corporation, partnership) (organization docs – partnership/LLC/corporation)
How long in business? __ Yrs ___ Mos. Income last year $ _______________
How many employees now? _____ Full-time ____ Part-time _____ Employer Tax ID#_______________
How Many Jobs will you add within one year?___ three years? _____ Pay Scale? $_____/hour Loan will be for? (describe)______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
FINANCIAL INFORMATION
List all your presently active loans and credit cards [you, your spouse and the business]
Company/Lender Account # Credit Limit Current Balance Monthly Payment 1st mortgage _________________________________________________________________________________
Business loan(s)
_________________________________________________________________________________ Other _________________________________________________________________________________
What bank (branch office) do you presently have checking and/or savings accounts with?
Also, what companies provide your: supplies, materials, equipment, and/or services of any kind?
Bank/Company Contact Person How Long Credit Limit Phone #___________ ___________________________________________________________________________________
ADDITIONAL INFORMATION
We will need the information detailed below, and your answers to these questions, to evaluate your loan request;
Please provide us:
! your most recent business financial information (profit and loss & balance sheet statements); ! your current business license # ______________ city? ______________;
! your business and personal tax return for the past two years; ! your most recent quarter’s sales tax and payroll tax returns;
! have you filed personal or business bankruptcy in the past seven (7) years? yes ____ no ____ ! are there any unsatisfied judgments against you or the business? yes ____ no ____ ! are you a co-signer or guarantor on any loans other than those shown above? yes ____ no ____
I/We authorize the Contra Costa County CDBG Program and/or their consultants to obtain employment / credit information regarding the above listed persons / businesses.
SIGNATURE _____________________________ SIGNATURE _______________________________
[Owner] [Spouse/Partner]
PLEASE NOTE: Businesses obtaining assistance involving federal (CDBG) funds must provide a Federal DATA UNIVERSAL NUMBERING SYSTEM (DUNS) number that categorizes your business. This number can be obtained by calling 1-866-705-5711 and telling the operator what kind of a business you have.
DUNS # ________________________.
SUGGESTED BUSINESS PLAN OUTLINE
In addition to financial information, a narrative plan is needed to introduce your business to lender(s) who will review your request for funds. A single paragraph for each item relevant to your business is suggested. Overall length of the narrative; a paragraph on each of the descriptive elements below should be 3 - 5 pages which is sufficient.
1) Description of the Business
! name and location
! legal structure (sole proprietorship, partnership, LLC, corporation, other) ! owners including name, address, telephone & percentage of ownership ! nature of business
! history of business 2) Product and/or Service
! describe the product(s) or type of service(s) you are involved in 3) Market Information
! market area(s) and expanding trends?
! customers & potential to acquire new customers ! competition, name(s), locations, and size (est. gross) ! advantage of your product/service over others
4) Management & Personnel
! management & key personnel expertise (position, qualifications, resume)
! describe your financial management system, including financial information that is regularly generated and by whom
! expand on your business and its future for the next 2 to 5 years
You may add additional information to help us better understand your business. This could include:
a. Product or service b. Marketing strategy - describe materials & supply sources - overall strategy
- methods of production - advertising/marketing styles - quality & cost of product/service - sales methods
- comparison to competitive products - pricing policy - terms of sale
c. Business facilities - method of distributing product
TELL US ABOUT YOUR EMPLOYEES, PERSONNEL POLICY AND TRAINING PROGRAM(S) LOAN APPLICATION CHECKLIST
Thank you for your loan application. In order to make the loan application process as easy as possible for you, and to insure that it is quickly reviewed, please provide the information, below, that is noted: We Need.
This information will be used only to evaluate your loan request. We We
Have Need
____ ____ Completed loan application form, and check for application fee; ____ ____ Use of Loan Funds - Detailed Spread Sheet;
____ ____ Current business license, home occupancy permit (if applicable), and tax I.D. number;
____ ____ Business Plan which describes your business, current and planned operations and demonstrates how the loan will assist your company goals;
____ ____ If applying for a Micro-Loan – provide a detailed break-down of ALL members of the Household and TOTAL Household income;
____ ____ Financial projections - three years by month - utilizing forms we provide and include: anticipated loan payments, payroll expenses, cost/price inflation factors;
Year end [last year/current year] financial information on your business including balance sheets/profit and loss statements;
____ ____ Business & Personal (if separate) tax returns for 2008 - 2007 for each owner with 20% or more of the business;
____ ____ Copy of lease agreement & options or mortgage verification; ____ ____ Personal resume for each owner;
____ ____ Detailed information regarding each present employee; (see attached form) [name/job/ethnicity/hourly scale/average monthly hours worked]
____ ____ DUNS Number (federal) that categorizes your business - Call 866-705-5711 and tell the operator what kind of a business you are engaged in;
____ ____ Corporate Resolution (if applicable) authorizing the applicant to borrow;
____ ____ If you are not a U.S. Citizen provide your place of birth and provide us with a copy of your green card or visa;
CONTRA COSTA COUNTY
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
Microenterprise/Very Small Business
(under $15,000)Loan Application
PERSONAL INFORMATION
Print Name _________________________________________ Home Telephone (___)__________ (last) (first) (middle)
Home Address _________________________________ ______________________ ___________
(street & no.) (city) (zip) Own ___ Rent___ How long? __ Yrs ___ Mos. Monthly rent or mortgage payments $__________ Social Security # ____-___-______ Married? ____ Single? ____ Separated?____ Divorced?_____
(documents if separated or divorced)
Children Residing in Household #__________
Spouse’s Name ____________________________ Annual Household Income $___________ Place of Birth ______________________________ U.S. Citizen ? ______yes ________ no
BUSINESS DETAILS
Business Legal Name _______________________ Doing Business As __________________________ Business Address ________________________ ______________ Is this Your Home? ____________
(street & no.) (city & zip) (home occupancy permit?) Business License?______________ Is This a Commercially Zoned Location?_______(permit required?) Business Telephone (___)__________ FAX (___)___________ E-mail Address ___________________ Monthly Rent? $_________ Lease Term? __________yrs Option to Extend? ______ years? ________ Organized as _______________________________________ (sole proprietor, corporation, partnership) (organization docs – partnership/LLC/corporation)
Is the business just starting? Yes ___ No ___ If No, how long in business? _____ Yrs ____ Mos Main Business Activity ________________________ Income last year $________
Are you the only worker? Yes___ No ___ How many other employees? ____ Full-time ____ Part-time Employer Tax ID#__________________ DUNS # ________________________.
Will you add employees over the next one/three years? _____ Pay Scale $________/hour
FINANCIAL INFORMATION
List all your presently active loans, leases, and credit cards [you, your spouse and the business]
Company/Lender Account # __ Monthly Payment Mortgage _______________________________________________________________________________
What bank (include branch office) do you presently have checking and/or savings accounts with? Also, what companies provide your: supplies, materials, equipment, and/or services of any kind?
Bank/Company Contact Person How Long Credit Limit Phone #________________ ________________________________________________________________________________________
ADDITIONAL INFORMATION
We will need the information detailed below, and your answers to these questions, to evaluate your loan request; Please provide us:
! your most recent business financial information (profit and loss & balance sheet statements); ! your current business license # ______________ city? ___________________________; ! your business and/or personal tax return for the past year;
! your most recent quarter’s sales tax and payroll tax returns;
! have you filed personal or business bankruptcy in the past seven (7) years? yes ____ no ____
! are there any unsatisfied judgments against you or the business? yes ____ no ____ ! are you a co-signer or guarantor on any loans other than those shown above? yes ____ no ____
I/We authorize the Contra Costa County CDBG Program and/or their consultants to obtain employment / credit information regarding the above listed persons / businesses.
SIGNATURE ________________________ SIGNATURE ________________________________
[Owner] [Spouse/Partner]
PLEASE NOTE: Businesses obtaining assistance involving federal (CDBG) funds must provide a Federal DATA UNIVERSAL NUMBERING SYSTEM (DUNS) number that categorizes your business. This number can be obtained by calling 1-866-705-5711 and telling the operator what kind of a business you have.
CONTRA COSTA COUNTY CDBG PROGRAM
Micro – Enterprise Household Income Qualification Criteria[income limits by household size – effective 3/19/09]
Maximum Qualifying Income of Household which is:
Persons per Low Income Household 1 $46,350 2 $53,000 3 $59,600 4 $66,250 5 $71,550 6 $76,850 7 $82,150 8 $87,450
CONTRA COSTA COUNTY
COMMUNITY
DEVELOPMENT BLOCK GRANT PROGRAM
This information is being requested for monitoring and auditing purposes, as required by HUD, and is not intended for public dissemination. Please provide the information below. Thank you for your cooperation.
_________________________________________ Male ___ Female ___ name
________________________________ __________________ ____________
street address city zip code
Check all that apply:
1/ Age? ___________ 62 or older? _____ Disabled? _____
2/Are you the “head of household?” Yes _____ No _____
3/ Is the “head of household” female? Yes _____ No _____
4/ Circle: a/Household Size and Circle: b/Total Household Income
a. Household Size b. Total Household Income
1 $18,750 or less $18,751 – 31,250 $ 31,251 - $46,350 2 21,450 or less 21,451 – 35,700 35,701 - 53,000 3 24,100 or less 24,101 - 40,200 40,201 – 59,600 4 26,800 or less 26,801 – 44,650 44,651 - 66,250 5 28,950 or less 28,951 – 48,200 48,201 – 71,550 6 31,100 or less 31,101 – 51,800 51,801 – 76,850 7 33,250 or less 33,251 – 55,350 55, 351 – 82,150 8 or more 35,400 or less 35,401 – 58,950 58,951 – 87,450
5/ Does the Household receive income from?
CalWorks ___ General Assistance ___ Social Security ___ Food Stamps ___ Medi-Cal ___
6/ Race (circle only one)
American Indian/Alaskan Native Asian Asian & White White
Native Hawaiian/Pacific Islander Black/African American Hispanic Ethnicity
American Indian/Alaskan Native & Black/African American Other Multi-Racial
The foregoing is true and correct to the best of my knowledge: ________________________________ signature date
Questions re: Initial Interview with Loan Prospects
1) Martial status…If divorced, we need copy of divorce decree. If legally separated, we need copy of legal separation document.
2) Number of household members?
3) Gross adjusted income in 2008….don’t know or can’t remember 2008? Then how much have you made thus far this year?
Same questions re: each member of the household.
4) Your current residence address. Any plans to move in near future?
5) Your current or planned business address. Any plans to relocate in near future? 6) How much money do you need to launch (or expand) your business?
7) How much of that amount are you planning to invest?
8) How will any deficiency in your project funding be covered? Remember: the CDBG
program will not make a loan to you if you don’t have the total funding lined up to succeed in your project.
9) Will you/do you work full time in your business? Do you anticipate the business making enough money to support you in the year to come? If not, what additional sources of income do you have to support yourself?
10) (If a start-up), why this particular business at this particular time?
11) What we need before we can proceed with the preparation of your loan application: (a) proof of U.S. citizenship
(b) check for $150
(c) copy of your credit report
12) (After reviewing the documents checklist with prospect), do you have any questions about our documentation requirements?
