Micro Loan Application
Instructions for completing the application:
Step 1: Submit Business Plan.
Step 1. Review the application checklist below. The materials listed will be used to determine financing eligibility for the INCREASE CDC Micro Loan Fund.
Step 2. Place a check mark next to each item that will be submitted along with this application. Upon review of the material submitted we may ask for more specific information regarding your business and loan request.
Step 3. Please print (or type) your information.
Step 4. Be sure each owner/partner of the business applying for the loan complete, sign and submits the required financial information.
Step 5. Submit ORIGINAL APPLICATION ONLY! Keep copy for yourself.
Step 6. Pay $80.00 application fee (per applicant, unless married) along with $20.00 credit report fee per applicant. These fees are non-refundable. Make checks payable to: INCREASE CDC
APPLICATION CHECKLIST:
___ $100 non-refundable processing fee
___ Business Plan (required) ___ Personal Financial Statement ___ Most Recent Personal Tax Return
___ Most Recent Business Federal Tax Return
___ Trade name Registration Certificate (Secretary of State)
___ Resume of owners & key management ___ Bank Statement/Deposit Slip (copy)
___ Two years of business financial projection ___ Use of funds sheet
___ Purchase order(s) for all items to be purchased with loan proceeds
___ Collateral information sheet(attached) ___ Insurance quote (if applicable) ___ References
___ Lease or purchase agreement (office, equipment, etc….)
___ Licenses and Permits (if applicable)
Applicant Contact Information (
For office use only)Name: ___________________________________ Contact Number: ( ) __________
Name: ___________________________________ Contact Number: ( )___________
Email:___________________________________ Fax:__________________________
Business Name: _________________________________
Date Submitted: _______________ Approved ____ Denied ____
PERSONAL INFORMATION
(PLEASE PRINT) (Owner # 1) Percentage of Ownership_______First Name: ____________________ MI:________ Last Name:__________________________________
Social Security Number: __________________ DOB (Month/Day/Year)________________________
Home Address: __________________________ City/State/Zip: _______________________________
Phone: _______________________ Driver Lic.#: ______________________Date Exp.:______________ (Owner #2) Percentage of Ownership_______
First Name: ____________________ MI:________ Last Name:__________________________________
Social Security Number: __________________ DOB (Month/Day/Year)________________________
Home Address: __________________________ City/State/Zip: _______________________________
Phone: _______________________ Driver Lic.#: ______________________Date Exp.:______________
Business owned by, or to be owned by Female Male Joint
Veteran Status Non Veteran Vietnam Veteran Other Veteran
Ethnic Background Black White Hispanic Puerto Rican
Native American Eskimo/Aleuts Multi-group
Asian/Pacific Islander Other
Personal references, with phone numbers. Please list three.
1.______________________________________________________________
2. ______________________________________________________________
Have you ever been convicted of a felony? Yes No
Please explain: ________________________________________________________
____________________________________________________________________
Application fee $100.00(processing, credit report): paid? Yes No
Starting w/your current or most recent job, list the last 3 places you worked.
Dates
worked Business name Title/responsibilities Contact name Phone #
HOUSEHOLD INFORMATION
Owner #1: Household Size? ______ Household Income: Per Mo.: $ __________ Year: $ ___________ Owner #2: Household Size? ______ Household Income: Per Mo.: $ __________ Year: $ ___________
BUSINESS INFORMATION
Business Name: _____________________ _____ _EIN # _ ___________ Address: _________________________________City/State/Zip_______________________________ Business Phone: ( )______________________ Website: ___________________________________ Registered with the State of Ohio Secretary of State: Yes or No (please circle one)
Type of business: Service Retail Wholesale Technology
Agricultural Manufacturing Construction
Food Service Production Transportation
Communication Other _______________________
What kind of skill development or Incubation/Business service(s) do you expect to need
during the start-up or expansion of your business?
□ Business Plan Writing
□ Capital Access
□ Computer Training
□ Marketing
□ Accounting/Bookkeeping
□ Other______________________
BUSINESS STATUS: ( mark one)
Business Status: ___ Exploring (Not Started) ___ Start-Up (Less than 1 Year) ___ Existing (More than 1 Year) Business Structure: ___Sole Proprietorship ___Partnership ___ LLC___S Corp___ C Corp ___Not established yet Date Business started: ____________________ Certified WBE/MBE/SBE Ownership (please circle all that apply) How many employees do you currently have: Full-time-_______________Part-time: ______________________ Provide a brief description of the business services/products: __________________________________ ___________________________________________________________________________________
GENERAL INFORMATION
Has the business, or any parties of the business ever filed bankruptcy?
____Yes ____ No--
If yes, please explain: ___________________________________________
__________________________________________________________________________________Has the business or any parties of the business ever been convicted of a felony crime?
____
Yes ____No--
If yes, please explain: ________________________________________________Does the business owner(s) have any personal/business judgments, liens, unsettled lawsuits or
disputes? ____Yes ____No
If yes, please explain: __________________________________________________________
Incubation/Business Services:
□ Office space
□ Mail box
□ Phone/Reception Services
□ Fax/Copier/Print/Scanner
□ Computer Usuage
□ Other ________________________
LOAN INFORMATION
Total loan request: $ __________________
Use of funds: $ __________Working Capital (Rent, Licensing, and Marketing) $ ______________Equipment $ ________Inventory
What collateral will you pledge: ___House ___Car ___Equipment ___Inventory ___Other
Owners cash investment in the business: $_____________________
Cash already spent for start up: $____________________________
Have you completed a business plan: ______Yes _____No
CREDIT REPORT AUTHORIZATION:
The information in this loan application is provided for the purpose of applying for funds from INCREASE CDC. All information in the application, attached business plan and personal financial statement is accurate to the best of my knowledge. It is my/our understanding that this information will be confidentially reviewed by the staff of INCREASE CDC and the INCREASE CDC Loan Review Committee. I understand that personal and/or business information may be requested pursuant to this loan application and I hereby give my consent for such information to be provided to INCREASE CDC. I also understand that INCREASE CDC retains the sole decision as to whether this loan application is approved, disapproved, or modified. It is my right to accept or decline the loan amount, rate, and terms approved by the program.I AUTHORIZE
INCREASE CDC to obtain a credit report on me through the credit reporting agency of its choice. If an adverse decision is made totally or partly due to theinformation on the credit report, INCREASE CDC will notify me of the reporting agency and will give me a denial letter stating the agency so that I may obtain a free credit report from them. This is your right under the Fair Credit Reporting Act
I UNDERSTAND that, if approved, INCREASE CDC may wish to use my business name and/or photos of my business activities for marketing, fundraising or other purposes, and I give my permission for the use of such information.
I UNDERSTAND all documents provided to INCREASE CDC are the property of INCREASE CDC unless otherwise noted and that INCREASE CDC may retain the information or dispose of it at any time.
Name (print) ______________________________ Name (print): _______________________________
Signature: ________________________________ Signature: __________________________________
Date: ____________________________________ Date: ______________________________________
