Fillable COVID-19 Emergency Small Business Loan Application %28download Fillable Form%29 - Rev050720 - COVID19 Emergency Small Business Loan Application

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COVID-19 Emergency Small Business Loan Application %28download Fillable Form%29 - Rev050720 - COVID19 Emergency Small Business Loan Application

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This organization is an equal opportunity provider, and employer.
Binghamton Local Development Corporation
City Hall, 4
th
Floor
38 Hawley Street
Binghamton, NY 13901-3776
(607) 772-7161
COVID-19 Emergency Small Business
Loan Application
The BLDC encourages sustainable development practices defined as
development which meets the needs of the present at the same time as
safeguarding and improving economic, social and environmental
resources and the ability of future generations to meet their own needs.
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
2
Contents
Application Checklist
Author
ization to Investigate Credit History
Borrower Statement
Personal History Statement
Personal Financial Statement
Signature Page
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
3
The following list will guide you as you complete your COVID19 Emergency Small Business Loan
Application package. This checklist must be reviewed with the BLDC Financial Analyst at the time
that the application is submitted.
Name of Borrowing Entity
_____ Exhibit 1
Completed Application: Checklist, Authorization to Investigate Credit
History, Borrower Statement, Personal History Statement, Personal Financial
Statement, Signature Page.
Borrower Information
_____
Exhibit 2
Copies of Individual Federal Tax Returns for the three (3) most recent years
for all principals having 20% or more ownership.
_____
Exhibit 3 Copy of a valid photo ID for every principal having 20% or more ownership.
_____
Exhibit 4
As appropriate to form of business organization, copies of Articles of
Incorporation, Certificate of Good Standing, Organization Agreement,
Bylaws and DBA; include % of ownership.
_____ Exhibit 5
Short narrative describing the business history, products, services, markets,
service area and customers, etc.
For an existing business, for the three most recent years provide:
_____
Exhibit 6 Complete copies of Borrowing Entity Federal Income Tax Returns.
_____
Exhibit 7
Accurate fiscal year-end financial statements including profit and loss
statements, balance sheets and cash flow acceptable to the BLDC.
Project Information
_____
Ex
hibit 8 Use of Funds Statement – amount of funds requested and intended use
_____
Exhibit 9
Provide a pro forma projection of monthly cash flow for the borrower. These
projections should account for the repayment of debt service. Describe the
assumptions on which projections are based.
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
4
The BLDC may require additional information to complete the analysis of your
application.
BLDC funds CANNOT be used for:
*Refinancing
*Payment for purchases made prior to project approval
*Speculative buildings or projects
*Not-for-profit entities
*Strictly residential development - mixed use may be considered
The BLDC complies with all the requirements imposed by Title IV of the Civil Rights Act of 1964
(Public Law 88-352); Title VII of the Civil Rights Act of 1968 (Public Law 90-284)' Section 109 of
Housing and Community Development Act of 1974; Section 3 of the Housing and Urban Development
Act of 1968; Executive Order 11246; Executive Order 11063, and any HUD regulations issued to
implement there Authorities and the regulations related to Equal Opportunity (24 CFR, Part 570-
601).
BLDC staff signature and date:
5
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
- AUTHORIZATION TO INVESTIGATE CREDIT HISTORY -
The undersigned authorizes the Binghamton Local Development Corporation (BLDC) to
obtain
all consumer and business information, including confirmation of bank accounts and credit
reports, and authorizes all reporting agencies to furnish such information to the BLDC
regarding this loan application. The undersigned agrees that the BLDC application and all
information obtained by the BLDC shall remain the property of the BLDC, whether or not the
loan is granted. The undersigned has read the loan program description, eligibility criteria,
and administrative guidelines, and agree to comply with the requirements and regulations set
forth by the United States Department of Housing and Urban Development (HUD) and the
BLDC. The undersigned acknowledges that the final terms of the loan, if approved, will be
based on the loan documents themselves, as approved by the BLDC’s counsel.
By: By:
Title: Title:
Date: Date:
By: By:
Title: Title:
Date: Date:
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
6
- BORROWER STATEMENT -
Borrowing Entity:
Business Name:
Borrowing Am
ount: $
(up to $15,000.00)
Con
tact name(s):
Bus
iness Address:
Busines
s Telephone: Number of Employees:
Tax ID No: Type of
Organization:
EIN:
__________________ DUNS #: ___________________
Years in Business: Nature of Business:
Fis
cal Year End: ____________________________
Name and Address of Current Bank of Business Account:
Owner Name:
Owner Address:
Owner Telephone: Social Security #:
Date of Birth:
% Ownership: Time as Owner:
Name and Address of Current Bank of Personal Account:
Owner Name:
Owner Address:
Owner Telephone: Social Security #:
Date of Birth:
% Ownership: Time as Owner:
Name and Address of Current Bank of Personal Account:
7
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
- PERSONAL HISTORY STATEMENT -
All principals having 20%
ownership or more or any other person providing a guarantee for the
loan must complete this form.
1. Personal Statement of: (first, middle initial, last name):
2. Date of Birth: Place of Birth:
3. Social Security Number:
4.Present residence address:
# years at this address
)
( )
5. Home Telephone Number: (
6. Business Telephone Number:
7. E-mail
8. Immediate past residence address:
Dates: From to
9.Current Employer:
Address
Date of Employment:
Business Telephone: ____________________ Yearly Salary: ____________________
10. Are you a U.S. Citizen? Yes, Naturalization Date (if applicable) ___________
______ No, Alien Registration #:___________________________
11. Ethnicity: _____White American _____Black American _____Native American
_____Hispanic American _____Asian/Pacific American _____Hasidic Jew
8
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
Personal History Statement, continued
12. Have you ever been involved in bankruptcy or insolvency proceedings?
________ No Yes
If yes, briefly describe details.
______________________________________________________
13. Are there or have there ever been any legal claims and judgments against you?
No Yes If yes, briefly describe details.
__________________________________________________________________________
14. Are you presently on parole or probation? ________No Yes
If yes, furnish details in a separate exhibit.
List name(s) under which held, if applicable.
15. Have you ever been convicted with any criminal offense other than a minor motor vehicle
violation? ______No Yes
If yes, furnish details in a separate exhibit.
List name(s) under which charged, if applicable.
A conviction will not necessarily disqualify you. Incorrect answers that constitute fraud are
disqualifying.
9
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
- PERSONAL FINANCIAL STATEMENT -
All principals having 20% ownership or more or any other person providing a guarantee for the
loan must complete this form.
ASSETS Dollars LIABILITIES Dollars
Cash, Checking, Savings, CDs
(see Schedule A)
Notes payable to banks and others
(see Schedule H)
US Gov’t & marketable securities
(see Schedule B)
Due to brokers
Non-marketable securities
(see Schedule C)
Amounts payable to others- secured
Securities held by broke
r
in margin accounts
Amounts payable to others- unsecured
Restricted control or margin
account stocks
Accounts & bills due
Real estate owned (see Schedule D) Unpaid income tax
Accounts, loans, & notes receivable Other unpaid taxes & interest
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
10
Please list any Assets or Liabilities that are held jointly with another party:
Automobiles
Real estate mortgages payable
(see Schedules D & H)
Cash surrender value-life insurance
(see Schedule E)
Vested interest in deferred
compensation/
profit-sharing plans (see Schedule F)
Business Ventures (see Schedule G)
Other Assets/personal property itemize
(see Schedule G if applicable)
Total Liabilities
Net Worth
Total Assets
Total Liabilities & Net Worth
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
11
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
Personal Financial Statement, continued
SCHEDULE A – CASH, CHECKING AND SAVINGS ACCOUNTS, CERTIFICATES OF DEPOSIT, MONEY MARKET FUNDS, ETC.
Name of Financial Institution Type of Account Owne
r
(J) If Pledged, to Whom? Balance
SCHEDULE B – U.S. GOVERNMENT & MARKETABLE SECURITIES (Use additional sheet if necessary)
Number of Shares
or Face Value of
Bonds
Description In Name o
f
Are these Registered,
Pledged, or held by
others?
Market
Value
Exchanges Where Traded
SCHEDULE C – NON-MARKETABLE SECURITIES (Use additional sheet if necessary)
Number of Shares Description In Name o
f
Are these Registered,
Pledged, or Held by
Others?
Value Method of Valuation
SCHEDULE D – INVESTMENTS IN REAL ESTATE (Use additional sheet if necessary)
Description/Location
of Real Estate
Investment
(J)
Date of Original
Investment/Amount
%
Owned
by You
Market
Value of
Your % of
Investment
Present
Balance
Monthly
Payment
Mortgage
Maturity
Date
Mortgage Owed To
SCHEDULE E – LIFE INSURANCE CARRIED INCLUDING GROUP INSURANCE
Name of
Insurance
Compan
y
Owner of Policy Beneficia
r
y and
Relationship
Face Amount Policy Loans Cash Surrender
Value
SCHEDULE F – VESTED INTEREST IN DEFERRED COMPENSATION/PROFIT SHARING PLANS
% Vested Company Name Account
Number
Manner of
Payout
(Annuity, Lump
Sum, etc)
Distribution
Date
Beneficiary Amount
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
12
You Are a Principal or a
Partner
in the
business
listed in
Section 3
Business Investment
SCHEDULE H – LOANS OWING BANKS, BROKERS, FINANCE COMPANIES, AND OTHERS (MASTERCARD, VISA, ETC.)
Owing to
(Acct. No.)
(J) Date of Original
Borrowing/Amount
Present
Balance
Due Monthly
Payment
Date of Final
Payment
Secured by
SCHEDULE G – BUSINESS VENTURES ( Use additional sheets if necessary)
List Name and Address of Any
Business Venture in Which
You
r
position/title
Line of
Business
Years in
Business
Total
Assets
Your % of
Ownership
Net Worth
of
Present Net
Value of Your
Personal Financial Statement, continued
BINGHAMTON LOCAL DEVELOPMENT CORPORATION
COVID-19 Emergency Small Business Loan Application
13
- SIGNATURE PAGE –
I declare that the statements made in this application – including attachments – are
true, correct, and complete to the best of my knowledge. False statements shall be
sufficient cause for dismissal of this application.
Signature Date
Company Title
Signature Date
Company Title
Please email the completed application to ecodev@cityofbinghamton.com
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Completed 11 July 2020

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