CONTRA COSTA COUNTY COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM Small Business Loan Application PERSONAL INFORMATION Print Name Home Telephone ( ) (last) (first) (middle) Home Address (street & no.) (city) (zip) Own Rent How long? Yrs Mos. Monthly rent or mortgage payments $ Social Security # - - Married? Single? Separated? Divorced? (documents if separated or divorced) Children Residing in Household # Spouse s Name Place of Birth Annual Household Income $ U.S. Citizen? yes no BUSINESS INFORMATION Business Legal Name Doing Business As Business Address Is this Your Home? (street & no.) (city & zip) (home occupancy permit?) Business License? Is This a Commercially Zoned Location? (permit required?) Business Telephone ( ) FAX ( ) E-mail Address Monthly Rent? $ Lease Term? yrs Option to Extend? years? Organized as (sole proprietor, corporation, partnership) (organization docs partnership/llc/corporation) How long in business? Yrs Mos. Income last year $ How many employees now? Full-time Part-time Employer Tax ID# Present employee pay scale (specify # at each hourly rate)
How Many Jobs will you add within one year? three years? Pay Scale? $ /hour Loan will be for? (describe) FINANCIAL INFORMATION List all your presently active loans and credit cards [you, your spouse and the business] Company/Lender Account # Credit Limit Current Balance Monthly Payment 1 st mortgage Business loan(s) Other What bank (branch office) do you presently have checking and/or savings accounts with? Also, what companies provide your: supplies, materials, equipment, and/or services of any kind? Bank/Company Contact Person How Long Credit Limit Phone # ADDITIONAL INFORMATION We will need the information detailed below, and your answers to these questions, to evaluate your loan request; Please provide us:! your most recent business financial information (profit and loss & balance sheet statements);! your current business license # city? ;! your business and personal tax return for the past two years;! your most recent quarter s sales tax and payroll tax returns;! have you filed personal or business bankruptcy in the past seven (7) years? yes no! are there any unsatisfied judgments against you or the business? yes no! are you a co-signer or guarantor on any loans other than those shown above? yes no I/We authorize the Contra Costa County CDBG Program and/or their consultants to obtain employment / credit information regarding the above listed persons / businesses.
SIGNATURE [Owner] SIGNATURE [Spouse/Partner] PLEASE NOTE: Businesses obtaining assistance involving federal (CDBG) funds must provide a Federal DATA UNIVERSAL NUMBERING SYSTEM (DUNS) number that categorizes your business. This number can be obtained by calling 1-866-705-5711 and telling the operator what kind of a business you have. DUNS #. SUGGESTED BUSINESS PLAN OUTLINE In addition to financial information, a narrative plan is needed to introduce your business to lender(s) who will review your request for funds. A single paragraph for each item relevant to your business is suggested. Overall length of the narrative; a paragraph on each of the descriptive elements below should be 3-5 pages which is sufficient. 1) Description of the Business! name and location! legal structure (sole proprietorship, partnership, LLC, corporation, other)! owners including name, address, telephone & percentage of ownership! nature of business! history of business 2) Product and/or Service! describe the product(s) or type of service(s) you are involved in 3) Market Information! market area(s) and expanding trends?! customers & potential to acquire new customers! competition, name(s), locations, and size (est. gross)! advantage of your product/service over others 4) Management & Personnel! management & key personnel expertise (position, qualifications, resume)! describe your financial management system, including financial information that is regularly generated and by whom 5) The Next Two to Five Years
! expand on your business and its future for the next 2 to 5 years You may add additional information to help us better understand your business. This could include: a. Product or service b. Marketing strategy - describe materials & supply sources - overall strategy - methods of production - advertising/marketing styles - quality & cost of product/service - sales methods - comparison to competitive products - pricing policy - terms of sale c. Business facilities - method of distributing product TELL US ABOUT YOUR EMPLOYEES, PERSONNEL POLICY AND TRAINING PROGRAM(S) LOAN APPLICATION CHECKLIST Thank you for your loan application. In order to make the loan application process as easy as possible for you, and to insure that it is quickly reviewed, please provide the information, below, that is noted: We Need. This information will be used only to evaluate your loan request. We We Have Need Completed loan application form, and check for application fee; Use of Loan Funds - Detailed Spread Sheet; Current business license, home occupancy permit (if applicable), and tax I.D. number; Business Plan which describes your business, current and planned operations and demonstrates how the loan will assist your company goals; If applying for a Micro-Loan provide a detailed break-down of ALL members of the Household and TOTAL Household income; Financial projections - three years by month - utilizing forms we provide and include: anticipated loan payments, payroll expenses, cost/price inflation factors;
Year end [last year/current year] financial information on your business including balance sheets/profit and loss statements; Business & Personal (if separate) tax returns for 2008-2007 for each owner with 20% or more of the business; Copy of lease agreement & options or mortgage verification; Personal resume for each owner; Detailed information regarding each present employee; (see attached form) [name/job/ethnicity/hourly scale/average monthly hours worked] DUNS Number (federal) that categorizes your business - Call 866-705-5711 and tell the operator what kind of a business you are engaged in; Corporate Resolution (if applicable) authorizing the applicant to borrow; If you are not a U.S. Citizen provide your place of birth and provide us with a copy of your green card or visa; Other.
CONTRA COSTA COUNTY COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM Microenterprise/Very Small Business (under $15,000) Loan Application PERSONAL INFORMATION Print Name Home Telephone ( ) (last) (first) (middle) Home Address (street & no.) (city) (zip) Own Rent How long? Yrs Mos. Monthly rent or mortgage payments $ Social Security # - - Married? Single? Separated? Divorced? (documents if separated or divorced) Children Residing in Household # Spouse s Name Place of Birth Annual Household Income $ U.S. Citizen? yes no BUSINESS DETAILS Business Legal Name Doing Business As Business Address Is this Your Home? (street & no.) (city & zip) (home occupancy permit?) Business License? Is This a Commercially Zoned Location? (permit required?) Business Telephone ( ) FAX ( ) E-mail Address Monthly Rent? $ Lease Term? yrs Option to Extend? years? Organized as (sole proprietor, corporation, partnership) (organization docs partnership/llc/corporation) Is the business just starting? Yes No If No, how long in business? Yrs Mos Main Business Activity Income last year $ Are you the only worker? Yes No How many other employees? Full-time Part-time Employer Tax ID# DUNS #.
Will you add employees over the next one/three years? Pay Scale $ /hour FINANCIAL INFORMATION List all your presently active loans, leases, and credit cards [you, your spouse and the business] Company/Lender Account # Monthly Payment Mortgage What bank (include branch office) do you presently have checking and/or savings accounts with? Also, what companies provide your: supplies, materials, equipment, and/or services of any kind? Bank/Company Contact Person How Long Credit Limit Phone # ADDITIONAL INFORMATION We will need the information detailed below, and your answers to these questions, to evaluate your loan request; Please provide us:! your most recent business financial information (profit and loss & balance sheet statements);! your current business license # city? ;! your business and/or personal tax return for the past year;! your most recent quarter s sales tax and payroll tax returns;! have you filed personal or business bankruptcy in the past seven (7) years? yes no! are there any unsatisfied judgments against you or the business? yes no! are you a co-signer or guarantor on any loans other than those shown above? yes no I/We authorize the Contra Costa County CDBG Program and/or their consultants to obtain employment / credit information regarding the above listed persons / businesses. SIGNATURE [Owner] SIGNATURE [Spouse/Partner] PLEASE NOTE: Businesses obtaining assistance involving federal (CDBG) funds must provide a Federal DATA UNIVERSAL NUMBERING SYSTEM (DUNS) number that categorizes your business. This number can be obtained by calling 1-866-705-5711 and telling the operator what kind of a business you have.
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CONTRA COSTA COUNTY CDBG PROGRAM Micro Enterprise Household Income Qualification Criteria [income limits by household size effective 3/19/09] Maximum Qualifying Income of Household which is: Persons per Household Low Income 1 $46,350 2 $53,000 3 $59,600 4 $66,250 5 $71,550 6 $76,850 7 $82,150 8 $87,450
CONTRA COSTA COUNTY COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM This information is being requested for monitoring and auditing purposes, as required by HUD, and is not intended for public dissemination. Please provide the information below. Thank you for your cooperation. Male Female name street address city zip code Check all that apply: 1/ Age? 62 or older? Disabled? 2/Are you the head of household? Yes No 3/ Is the head of household female? Yes No 4/ Circle: a/household Size and Circle: b/total Household Income a. Household Size b. Total Household Income 1 $18,750 or less $18,751 31,250 $ 31,251 - $46,350 2 21,450 or less 21,451 35,700 35,701-53,000 3 24,100 or less 24,101-40,200 40,201 59,600 4 26,800 or less 26,801 44,650 44,651-66,250 5 28,950 or less 28,951 48,200 48,201 71,550 6 31,100 or less 31,101 51,800 51,801 76,850 7 33,250 or less 33,251 55,350 55, 351 82,150 8 or more 35,400 or less 35,401 58,950 58,951 87,450 5/ Does the Household receive income from? CalWorks General Assistance Social Security Food Stamps Medi-Cal 6/ Race (circle only one) American Indian/Alaskan Native Asian Asian & White White Native Hawaiian/Pacific Islander Black/African American Hispanic Ethnicity American Indian/Alaskan Native & Black/African American Other Multi-Racial The foregoing is true and correct to the best of my knowledge: signature date
Questions re: Initial Interview with Loan Prospects 1) Martial status If divorced, we need copy of divorce decree. If legally separated, we need copy of legal separation document. 2) Number of household members? 3) Gross adjusted income in 2008.don t know or can t remember 2008? Then how much have you made thus far this year? Same questions re: each member of the household. 4) Your current residence address. Any plans to move in near future? 5) Your current or planned business address. Any plans to relocate in near future? 6) How much money do you need to launch (or expand) your business? 7) How much of that amount are you planning to invest? 8) How will any deficiency in your project funding be covered? Remember: the CDBG program will not make a loan to you if you don t have the total funding lined up to succeed in your project. 9) Will you/do you work full time in your business? Do you anticipate the business making enough money to support you in the year to come? If not, what additional sources of income do you have to support yourself? 10) (If a start-up), why this particular business at this particular time? 11) What we need before we can proceed with the preparation of your loan application: (a) proof of U.S. citizenship (b) check for $150 (c) copy of your credit report 12) (After reviewing the documents checklist with prospect), do you have any questions about our documentation requirements? Are there any requirements that you believe you will have trouble meeting?