Open for Business Loan Application Open for Business Loan Application The Kerr-Tar Regional Council of Governments Open for Business Loan Program helps finance existing local small to medium size businesses throughout a 5-county region recover from the COVID-19 crisis. Eligible businesses should be small to medium size (1-99 employees) existing businesses who have been in business for at least 12 months, and must be located in Franklin, Granville, Person, Vance, and Warren counties. Documentation providing evidence of a loss in revenue since the start of the COVID-19 pandemic is required. Business owners may apply for a 5-10 year, interest free loan ranging from $10,000-$100,000. All loans will require a personal guarantee and some additional collateral. Funds may be used for working capital and/or equipment and require an application fee of $200. Standard loan terms of 10 years on equipment and 5 years on working capital. Flexibility in payback period will be considered if requested and approved by the COG Board. Years of business operation and proximity to downtown areas are weighted preferences for loan approval. A. Contact InformationPlease provide the following information.Applicant Information* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*FranklinGranvillePersonVanceWarrenLast 4 digits of Social Security Number*Date of Birth* MM DD YYYY Primary Phone*Secondary PhoneNC Driver's License Number*Email Address* Gender*MaleFemalePrefer not to sayCo-Applicant Information (if applicable) First Last Co-Applicant Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Co-Applicant Last 4 digits of Social Security NumberCo-Applicant Date of Birth MM DD YYYY Co-Applicant Primary PhoneCo-Applicant Secondary PhoneCo-Applicant NC Driver's License NumberCo-Applicant Email Address Co-Applicant GenderMaleFemalePrefer not to sayB. Business InformationPlease provide the following information. Business Name*Federal Tax ID*Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Type*Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentClerical/AdministrativeConstruction/FacilitiesCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherIf other, please specify.Briefly describe your business.*How is your business structured?*LLCSole ProprietorshipPartnershipS CorporationC CorporationWhat percentage ownership do you have in your business?*Should your request be approved, each owner of 20% or more must sign the Loan Agreement. How many employees do you have?*Number of jobs saved/retained by borrowing these funds*Last year's gross revenues*Are you in active bankruptcy?*YesNoWho are your current customers? How do you earn revenue?*Briefly describe how COVID-19 has impacted your business.*Please be as specific as possible. C. General Demographic QuestionsThe following information is required for program reporting and statistical monitoring. Your response will not affect consideration of your application. How do you or your organization identify?* White Black Asian Native American Native Hawaiian/Other Pacific Islander Other/Multi-Racial Ethnicity*HispanicNot HispanicVeteran of the U.S. Military*YesNoDoes this qualify as a minority owned business (MBE)?*YesNoDoes this business qualify as a woman owned business (WBE)?*YesNoIs your business located in a downtown area?*YesNoYears of Operation*1-3 years4-5 years6-8 years9-10 years11-20 years20+ yearsD. Loan RequestPlease provide the following information. Requested Loan Amount*How do you intend to secure loan?*Collateral*List available collateral to secure loan (e.g. vehicle, property, equipment). Click the + to add a new row. Assets available to secure this loan (describe)Asset ValueLoans on Asset How would you utilize these funds should your business be approved for a loan?*Examples include: 1) Payroll, 2) Rent/Lease, 3) Inventory, 4) Equipment, 5) Other. Click the + to add a new row. Use of FundsAmount $ Based on the table above, please enter specific details.*Describe any other sources of funding you have received for COVID-19 relief (State, Local, Federal, or non-profit funding). Other funding sources are not a disqualifying factor.Where/how did you find out about this loan opportunity?*Check all that apply Newspaper Online Advertisement Billboard Radio Social Media Chamber of Commerce or Economic Development Professional Word of Mouth Other E. Conflict of Interest & AssurancesPlease provide the following information. Conflict of Interest Policy Acknowledgement: Please Initial*In order to preclude any perceived or real conflict of interest, the applicant acknowledges that he/she has no familial, business or any financial relationship with any member of the Board of Directors or staff of the Kerr-Tar Regional Council of Governments. Further, the applicant certifies that he/she will not use any funds awarded through this loan to influence or attempt to influence an officer or employee of any federal or state agency or a member of Congress or the North Carolina General Assembly. CARES Act Assurance: Please Initial*All loan proceeds will be used only for business-related purposes as specified in this loan application and consistent with the Coronavirus Aid, Relief, and Economic Security Act. Non-Discriminatory Assurance: Please Initial*The business for which these funds will be used will not discriminate in any business practice, including employment practices and services to the public on the basis of race, color, national origin, race, color, religion, marital status, handicap, age, or national origin. F. Required DocumentsPlease download and complete the Certification of Downtown Business Operation and upload below. 2019 or earlier Tax Returns*If no tax returns, need other documentation of business revenue.Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx.2-3 State Sales Tax Reports PRIOR to March 1, 2020* Drop files here or Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx. 2-3 most recent State Sales Tax Reports AFTER March 1, 2020*If you do not have the requested documentation, please submit other financial records reflecting loss of revenue since March 1, 2020. Drop files here or Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx. Registration with the State of North Carolina*Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx.Financial documentation reflecting a direct loss in revenue due to COVID-19.*For example, 2-3 most recent sales tax reports, drop in payroll, profit & loss statement, bank statement, or other documentation. Drop files here or Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx. Photo ID*Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx.Proof of Insurance*Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx.SubmitThe undersigned hereby authorizes the Kerr-Tar Regional Council of Governments or any of its affiliates to make all inquiries with credit bureaus and others it deems necessary--including business counselors, consultants, and partnering agencies--to verify the accuracy of the information provided herein and to determine credit worthiness. Further, the undersigned hereby certifies that the enclosed application information is valid, accurate, and complete. Signature*Date* Date Format: MM slash DD slash YYYY
