Paycheck Protection Program
Borrower Application Form Revised March 3, 2021
Purpose of this form:
This form is to be completed by the authorized representative of the Applicant and submitted to your SBA Participating Lender. Submission of the requested
information is required to make a determination regarding eligibility for financial assistance. Failure to submit the information would affect that
An Applicant that files an IRS Form 1040, Schedule C, and elects to calculate the PPP loan amount using net profit must use this form. An Applicant that
files an IRS Form 1040, Schedule C, and elects to calculate the PPP loan amount using gross income cannot use this form, and instead must use SBA Form
2483-C. An Applicant that files an IRS Form 1040, Schedule F, and calculates the PPP loan amount using gross income must also use this form.
Instructions for completing this form:
With respect to Purpose of the Loan, payroll costs consist of compensation to employees (whose principal place of residence is the United States) in the
form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips or, in the absence of such
records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or sick leave (except those paid leave
amounts for which a credit is allowed under FFCRA Sections 7001 and 7003); allowance for separation or dismissal; payment for the provision of employee
benefits (including insurance premiums) consisting of group health care coverage, group life, disability, vision, or dental insurance, and retirement benefits;
payment of state and local taxes assessed on compensation of employees; and, for an independent contractor or sole proprietor, wage, commissions, income,
or net earnings from self-employment or similar compensation.
For purposes of calculating Average Monthly Payroll, most Applicants will use the average monthly payroll for 2019 or 2020, excluding costs over $100,000
on an annualized basis,
as prorated for the period during which the payments are made or the obligation to make the payments is incurred, for each employee.
For seasonal businesses, the Applicant may elect to instead use average total monthly payroll for any twelve-week period selected by the Applicant between
February 15, 2019 and February 15, 2020, excluding costs over $100,000 on an annualized basis, as prorated for the period during which the payments are
made or the obligation to make the payments is incurred, for each employee. For new businesses, average monthly payroll may be calculated using the time
period from January 1, 2020 to February 29, 2020, excluding costs over $100,000 on an annualized basis, as prorated for the period during which the
payments are made or the obligation to make the payments is incurred, for each employee. For farmers and ranchers that operate as a sole proprietorship or
as an independent contractor, or who are eligible self-employed individuals and report farm income or expenses on a Schedule F (or any equivalent successor
IRS form), payroll costs are computed using eligible payroll costs for employees, if any, plus the lesser of $100,000 and the difference between gross income
and any eligible payroll costs for employees, as reported on a Schedule F. For Applicants that file IRS Form 1040, Schedule C, and elect to calculate the
PPP loan amount using net profit, payroll costs are computed using line 31 net profit amount, limited to $100,000, plus any eligible payroll costs for
employees (to calculate loan amount using gross income, see SBA Form 2483-C). For Applicants that are partnerships, payroll costs are computed using
net earnings from self-employment of individual general partners, as reported on IRS Form 1065 K-1, reduced by section 179 expense deduction claimed,
unreimbursed partnership expenses claimed, and depletion claimed on oil and gas properties, multiplied by 0.9235, that is not more than $100,000, plus any
eligible payroll costs for employees.
For purposes of reporting Number of Employees, sole proprietors, self-employed individuals, and independent contractors should include themselves as
employees (i.e., the minimum number in the box Number of Employees is one). Applicants may use their average employment over the time period used
to calculate their aggregate payroll costs to determine their number of employees. Alternatively, Applicants may elect to use the average number of
employees per pay period in the 12 completed calendar months prior to the date of the loan application.
For purposes of reporting Year of Establishment, self-employed individuals and independent contractors may enter “NA”.
For purposes of reporting NAICS Code, applicants must match the business activity code provided on their IRS income tax filings, if applicable.
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020 and April
3, 2020 to Loan Request as indicated on the form. Do not add the amount of any EIDL Advance.
All parties listed below are considered owners of the Applicant:
• For a sole proprietorship, the sole proprietor;
• For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm;
• For a corporation, all owners of 20% or more of the corporation;
• For limited liability companies, all members owning 20% or more of the company; and
• Any Trustor (if the Applicant is owned by a trust).
For purposes of reporting (optional) demographic information:
1. Purpose. Veteran/gender/race/ethnicity data is collected for program reporting purposes only.
2. Description. This form requests information about each of the Applicant’s Principals. Add additional sheets if necessary.
3. Definition of Principal. The term “Principal” means:
• For a self-employed individual, independent contractor, or a sole proprietor, the self-employed individual, independent contractor, or sole
• For a partnership, all general partners and all limited partners owning 20% or more of the equity of the Applicant, or any partner that is
involved in the management of the Applicant’s business.
• For a corporation, all owners of 20% or more of the Applicant, and each officer and director.
• For a limited liability company, all members owning 20% or more of the Applicant, and each officer and director.
• Any individual hired by the Applicant to manage the day-to-day operations of the Applicant (“key employee”).
• Any trustor (if the Applicant is owned by a trust).
• For a nonprofit organization, the officers and directors of the Applicant.
4. Principal Name. Insert the full name of the Principal.
5. Principal Position. Identify the Principal’s position; for example, self-employed individual; independent contractor; sole proprietor; general
partner; owner; officer; director; member; or key employee.