SBA - Disaster Loan Assistance

Business Legal Name

Trade Name

EIN/SSN for Sole Proprietorship

Organization Type

Is the Applicant a Non-Profit Organization?

Yes

No

Is the Applicant a Franhcise?

Yes

No

Gross Revenues for the Twelve(12) Month Prior to the Date of the Disaster (January 31, 2020)

Cost of Goods Sold for the Twelve(12) Month Prior to the Date of the Disaster (January 31, 2020)

Rental Properties (Residential and Commercial) Only - Lost Rents Due to the Disaster

Non-Profit Cost of Operation for the Twelve(12) Month Prior to the Date of the Disaster (January 31, 2020)

Combined Annual Operating Expenses for the Twelve(12) Months Prior to the Date of the Disaster (January 31, 2020) for All Secular Social Services Provided by the Faith Based Entity

List the Secular Social Services Provided by the Faith Based Entity

Compensation From Other Sources Received as a Result of the Disaster

Provide Brief Description of Other Compensation Sources

Primary Business Address (Cannot be P.O. Box)

City

State

County

Zip

Business Phone

Alternative Business Phone

Business Fax

Business Email

Date Business Established

Current Ownership Since

Business Activity

Detailed Business Activity*

Number of Employees (As of January 31, 2020)

Business Information