Ripley County Revolving Loan Program

Section I: BUSINESS INFORMATION

Owner's name*

Home Address*

Home Phone*

Name of Business*

Business Address*

City*

Zip Code*

Business Phone*

Fax Number *

Business Email*

Briefly describe the business product or service*

Organization Type* "S" Corporation"C" CorporationSole ProprietorshipPartnershipStartup BusinessOther

Federal ID#*

Date Business Established*

SECTION II: EMPLOYMENT INFORMATION

Number of Employees*

Avg. Hourly Rate*

Hours Per Week*

#Full Time*

#Part Time*

#Owner & Family

Total Number of Jobs That Will Be Created*

Total Number of Jobs That Will Be Retained*

@Hourly Rate*

Hours Per Week*

SECTION III: PROJECT INFORMATION

Total Project Cost*

Amount of Loan Requested*

Other Sources of Funding* (if applicable)

Repayment Term Requested in Months*

Project Description*

/ USE OF FUNDS /

1. EQUIPMENT
Description*
Loan funds*
Other funds*

2. FIXTURES
Description*
Loan funds*
Other funds*

3. ACQUISITION
Description*
Loan funds*
Other funds*

4. CONSTRUCTION
Description*
Loan funds*
Other funds*

5. INVENTORY
Description*
Loan funds*
Other funds*

6. OTHER
Description*
Loan funds*
Other funds*

TOTAL LOAN FUNDS*

TOTAL OTHER FUNDS*

Please Describe the Anticipated Sources of Payment*

Proposed Collateral*

What Measures Have You Taken To Obtain Traditional Financing?*

Contacts Made*

Please Provide 3 Credit References (Name, Address, Phone)*

SECTION V: OTHER FINANCIAL INFORMATION

Do you currently have any invoices more than 30 days past due?* YesNo

ITEMS NEEDED TO COMPLETE LOAN APPLICATION:

2 years of tax returns*
Year 1
Year 2

Business Plan*

Financial Statement for previous year*

Verification of use of funds* (copy of new contract, estimate for new equipment, repairs, etc.).

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