FLORIDA SMALL BUSINESS EMERGENCY BRIDGE LOAN APPLICATION

Transcription

1 FLORIDA SMALL BUSINESS EMERGENCY BRIDGE LOAN APPLICATION Disaster Event: Hurricane Michael (Applicatin Deadline December 7, 2018) LOAN AMOUNT REQUESTED: (Maximum $50,000) * Lans f up t $100,000 may be made in special cases as warranted by the need f the business LOAN TYPE: (check all that apply) What type f damage did yur business suffer? APPLICATION DATE: Physical Damage -- Indicate type f damage Real Prperty Business Cntents Attach phtgraphs r images f damage t yur business prperty r cntent, r estimates fr replacing r repairing prperty damaged as a result f the declared disaster. Ecnmic Injury (Lss f Sales r Revenues) Attach written justificatin f ecnmic lss r injury caused as a result f r perid declared disaster, e.g. sales r incme cmpared t previus year cmpared t current perid. EXPECTED SOURCE OF REPAYMENT: SBA Disaster Lan(s) Other Federal Aid Insurance Prceeds Bank r Other Lan Was yur business als impacted by Hurricane Irma? (this questin is being used fr statistical infrmatin) N ONLY ELIGIBLE AND COMPLETED APPLICATIONS WITH REQUIRED SUPPORTING DOCUMENTATION WILL BE ACCEPTED. PLEASE READ ENTIRE FORM BEFORE SUBMITTING Submit Applicatin and Required Dcuments t yur lcal Flrida Small Business Develpment Center. T lcate yur lcal Flrida SBDC visit OR send cmpleted applicatins and required dcuments t: Flrida SBDC Netwrk Headquarters C/O Flrida Emergency Bridge Lan Prcess 220 West Garden Street, Suite 301 Pensacla, Flrida Fr questins, cntact Flrida SBDC Netwrk Headquarters, Disaster Infrmatin Htline, Disaster@FlridaSBDC.rg r tll-free (866) P a g e

2 SECTION I. APPLICATION SIGNATURE The undersigned, by signature n this dcument, verifies that infrmatin cntained herein and in all attachments and all supprting dcuments and materials are true and cmplete, that I/we have authrity t apply fr this lan n behalf f the business, and intend t repay the lan using funds available t myself/us r the business that will be used t repay the lan. The undersigned understands that Flrida First Capital Finance Crpratin, and/r ther financial institutins assisting the Crpratin in its administratin f this lan prgram fr the State f Flrida, may investigate the credit f the applicant r capplicants fr purpses limited t this applicatin, and hereby authrized such investigatin. APPLICANT(S) SIGNATURE(S) APPLICANT 1 (16A) APPLICANT 2 (16B) APPLICANT 3 (16C) APPLICANT 4 (16D) SECTION II. ELIGIBILITY YOUR BUSINESS MUST BE: 1. A fr-prfit, privately held small businesses that maintains a place f business in the state f Flrida and established prir t Octber 7, A small business lcated in a designated cunty in Flrida. Eligible Flrida cunties per Executive Orders and (amended): Alachua, Baker, Bay, Bradfrd, Calhun, Citrus, Clumbia, Dixie, Escambia, Franklin, Gadsden, Gilchrist, Gulf, Hamiltn, Hernand, Hillsbrugh, Hlmes, Jacksn, Jeffersn, Lafayette, Len, Levy, Liberty, Madisn, Manatee, Okalsa, Pasc, Pinellas, Santa Rsa, Suwanee, Taylr, Unin, Wakulla, Waltn and Washingtn. 3. A small business emplyer with up t 100 emplyees.** 4. Must have paid in full previus lans received frm the state emergency bridge lan prgram. **Emplyees are defined as individuals wh receive paid wages r salary which emplyment taxes (e.g. FICA, FUTA) and incme taxes are withdrawn and remitted t the IRS, as evidenced by business tax returns filed, i.e. IRS Frm 940, Emplyer s Annual Federal Tax Return, IRS Frm 941, Emplyer's Quarterly Federal Tax Return r IRS Frm W-3, Transmittal f Wage and Tax Statements. Fr purpses f eligibility, independent cntractrs (als knwn as 1099 emplyees) d nt qualify as emplyees fr this lan prgram. ALL OF THE ABOVE MUST BE TRUE TO BE ELIGIBLE FOR THIS PROGRAM. INELIGIBLE BUSINESSES: 1. A business deriving mre than ne-third f grss annual revenue frm legal gambling activities. 2. A business engaged in any illegal activity. 3. A business that present live perfrmances f an indecent sexual nature r derive directly r indirectly mre than 2.5 percent f grss revenues thrugh the sales f prducts and services, r the presentatin f any depictins r displays, f an indecent sexual nature, r the presentatin f any depictin r displays, f an indecent sexual nature. 4. A business that has a primary purpse f facilitating plyamrus relatinships. 5. Massage parlrs. 6. Ht tub facilities. 7. Escrt services. 2 P a g e

3 INELIGIBLE BUSINESSES DO NOT QUALIFY FOR THIS LOAN PROGRAM. INTEREST RATES: Lans will be interest free fr the term f the lan (1 year). Interest rate will be 12% per annum n the unpaid balance thereafter, until the lan balance is repaid in full. LOAN DEFAULT NOTICE: Each lan must be repaid in full by the maturity date established in the lan prmissry nte. Any lan nt repaid in full n r befre the maturity date will be cnsidered in default. A defaulted lan will incur interest and may be assigned t a cllectin agency. In the event f default, the brrwer will be respnsible fr the full amunt f the lan principal, interest, and cllectin agency fees. SECTION III. REQUIRED APPLICANT DOCUMENTATION REQUIRED LOAN APPLICATION DOCUMENTS: 1) Sectin III f this applicatin frm cmpleted and signed by individual(s) wh, individually r cllectively, wn fifty-ne percent (51%) r mre f the equity f the business, as evidenced by the businesses tax statements. 2) Business Tax Returns At a minimum, cpies f the 2016 and 2017 federal incme tax returns fr the applicant business, including all schedules, r a written explanatin if the tax return(s) are nt available. Sle Prprietrship Frm 1040, US Individual Incme Tax Return, Sch. C, Prfit r Lss frm Business Partnerships Frm 1065, U.S. Return f Partnership Incme, Schedule K-1, Partners Share f Incme, Deductins and Credits Crpratins Frm 1120, U.S. Crpratin Incme Tax Return S Crpratins Frm 1120S, U.S. S-Crpratin Incme Tax Return Nte: Limited Liability Cmpany (LLC) IRS will treat an LLC as either a crpratin, partnership, r as part f the LLC s wner s tax return (a disregarded entity ). Specifically, a dmestic LLC with at least tw members is classified as a partnership (Frm 1065) fr federal incme tax purpses unless it files Frm 8832 and affirmatively elects t be treated as a crpratin (Frm 1120 r 1120S). And an LLC with nly ne member is treated as an entity disregarded as separate frm its wner fr incme tax purpses (Frm 1040, Schedule C). 3) Emplyer Tax Dcumentatin (ne f the fllwing) 2017 Emplyer s Annual Federal Tax Return (IRS Frm 940) 2017 Emplyer's Quarterly Federal Tax Return (IRS Frm 941) 2017 W-3s r W-2s fr minimum f tw emplyees 4) Individual Tax Returns At a minimum, cpies f the 2016 and 2017 federal incme tax returns, IRS Frm 1040 and all schedules, fr each individual business wner wh cmpleted and signed this applicatin. COLLECT ALL REQUIRED SUPPORTING DOCUMENTS BEFORE COMPLETING APPLICATION. APPLICANT MAY VOLUNARILY PROVIDE ADDITIONAL INFORMATION THAT WILL ADD CONTEXT AND ASSIST THE LOAN COMMITTEE IN MAKING AN INFORMED LOAN DECISION. ADDITIONAL INFORMATION MAY INCLUDE: Year-end financial statements fr the past tw tax years. Interim financial statements (prfit & lss) fr the current year-t-date. Additinal filing requirements prviding mnthly sales figures. Explanatin f credit reprt cncerns and issues. ADDITIONAL INFORMATION MAY BE REQUESTED BY THE LOAN COMMITTEE TO DETERMINE A LOAN DECISION. IF REQUESTED, PLEASE PROVIDE ADDITIONAL INFORMATION WITHIN 7 DAYS OF THE REQUEST. 3 P a g e

4 SECTION IV. APPLICATION FORM 1. ORGANIZATION TYPE: Sle Prprietrship Partnership Crpratin S-Crpratin Limited Liability Cmpany Other: 2. BUSINESSES LEGAL NAME: (verified by Sunbiz.rg) 3. TRADE NAME: (if different than legal name) 4. EIN (EMPLOYER IDENTIFICATION NUMBER): 5. REEMPLOYMENT ASSISTANCE TAX NUMBER (RA): 6. MAILING ADDRESS: Business Hme Temp Other Number, Street, and/r Pst Office Bx: City Cunty State Zip Cde 7. BUSINESS PROPERTY ADDRESS(ES) Number and Street 1. DO YOU: Own Lease City Cunty State Zip PRIMARY BUSINESS ACTIVITY: 10.NUMBER OF EMPLOYEES AND AVERAGE WAGE: (predisaster) 11. DATE BUSINESS ESTABLISHED: (MM/YYYY) 12. BUSINESS FINANCIAL SUMMARY (YTD, if available) Grss Revenues Ttal Emplyment/Payrll Expense Pre-Tax Prfit 13. CREDIT INFORMATION Business Bank (Primary) Cntact (if any) 4 P a g e

5 Accunt Type (Checking, Savings, IRA, etc.) Key Creditr / Vendr Cntact (if any) Accunt Type (Credit Card, Accunts Payable, Open Line, etc.) Key Creditr / Vendr Cntact (if any) Accunt Type (Credit Card, Accunts Payable, Open Line, etc.) 14. AMOUNT OF ESTIMATED LOSS: (if unknwn, enter a questin mark) Real Estate: Leasehld Imprvements: Machinery and Equipment: Lss f Sales: Inventry: Other: 15. INSURANCE COVERAGE (IF ANY) Cverage Type: Prperty Insurance Business Interruptin Insurance Other f Insurance Cmpany and Agent: Phne Number f Insurance Agent: Plicy Number: 16. Describe the type and extent f physical damage and/r ecnmic injury that yur business has experienced as a result f the declared disaster. Attach phtgraphs r ther evidence f the physical damage. 17. OWNERS: (must include all the fllwing infrmatin) Applicatin must include the fllwing infrmatin fr the individual(s) wh, individually r cllectively, wn at least fifty-ne percent (51%) f the equity f the business, as evidenced by the businesses tax statements. (A) OWNER APPLICANT 1: (if less than 51% wner, additinal wner applicant(s) are needed) 5 P a g e

6 Scial Security Number f Birth Driver s License Number (area (B) OWNER APPLICANT 2: (if applicant 1 is less than 51% wner) Scial Security Number f Birth Driver s License Number (area (C) OWNER APPLICANT 3: (if applicants 1 and 2 are less than 51% wner) Scial Security Number f Birth Driver s License Number (area (D) OWNER APPLICANT 4: (if applicants 1-3 are less than 51% wner) Scial Security Number f Birth Driver s License Number (area * Ttal f all wners listed must be equal t r greater than 51% f ttal business wnership. Attach additinal sheet if needed. 18. IF DIFFERENT THAN 17(A) and 17(B) ABOVE, PROVIDE THE NAME(S) OF THE INDIVIDUAL(S) TO CONTACT FOR INFORMATION NECESSARY TO PROCESS THIS APPLICATION: (Primary) (Alternative) 6 P a g e

7 19. If anyne assisted yu in cmpleting this applicatin, whether yu pay a fee fr this service r nt, that persn must print and sign their name in the space belw. and Address f Representative (please include the individual name and their cmpany) f Individual Print Individual f Cmpany Phne Number (include Area Cde) Street Address City, State, Zip Unless the NO bx is checked, I give permissin t discuss any prtin f this applicatin with the representative listed abve. NO SECTION V. BORROWER CERTIFICATION AND ACKNOWLEDGMENT I/We understand that the State f Flrida Small Business Emergency Bridge Lan Prgram is designed t prvide a shrt-term lan t bridge the gap between the time a majr catastrphe ccurs and when a business has secured ther capital resurces. I/We understand that I/we are respnsible fr repayment f any funds laned under the Prgram. I/We intend t repay the lan thrugh ne r mre f the fllwing surces: I/We have applied r intend t apply fr a U.S. Small Business Administratin (SBA) Disaster Lan, SBA Disaster Lan(s) r ther Federal Assistance. I/We have applied r intend t apply fr a lan frm my banking institutin. I/We have filed a claim with ur insurance cmpany fr damages. I/We will have ther resurces available t repay the lan. APPLICANT(S) SIGNATURE(S) APPLICANT 1 (16A) APPLICANT 2 (16B) APPLICANT 3 (16C) APPLICANT 4 (16D) [END OF APPLICATION] Applicatin Hurricane Michael E C2395 EBL 7 P a g e