disaster business loan application sba

7/29/2019 Disaster Business Loan Application SBA

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DISASTER BUSINESS LOAN APPLICATION

Physical Declaration Number Filing Deadline Date

Economic Injury Declaration Number Filing Deadline Date

FEMA Registration Number SBA Application Number

(if known)

1. ARE YOU APPLYING FOR:

Physical Damage -- Indicate type of damage Military Reservist EIDL (MREIDL)

* Name of Essential Employee

* Employee's Social Security Number

2. ORGANIZATION TYPE

Sole Proprietorship Partnership Limited Partnership Limited Liability Entity

Corporation Nonprofit Organization Trust Other:

3. APPLICANT'S LEGAL NAME 4. FEDERAL E.I.N. (if applicable)

5. TRADE NAME (if different from legal name) 6. BUSINESS PHONE NUMBER (including area code)

Business Contents

Economic Injury (EIDL)

* For information about these questions, see the attached Statements Required by Laws and Executive Orders.PLEASE PROVIDE ALL INFORMATION OR DOCUMENTATION REQUESTED IN THE ATTACHED FILING REQUIREMENTS.

Real Property

U. S. Small Business Administration

FOR SBA INTERNAL USE ONLY

(complete the following)

OMB No. : 3245-0017

Expiration: 01/31/2015

5. TRADE NAME (if different from legal name) 6. BUSINESS PHONE NUMBER (including area code)

7. MAILING ADDRESS Business Home Temp Other:

Number, Street, and/or Post Office Box City County State Zip

8.

Number and Street Name City County State Zip

9. PROVIDE THE NAME(S) OF THE INDIVIDUAL(S) TO CONTACT FOR:

Loss Verification Inspection Information necessary to process the Application

Name Name

Telephone Number Telephone Number

10. ALTERNATE WAY TO CONTACT YOU

Cell Number

Fax Number

E-mail

Other

11. BUSINESS ACTIVITY:

DATE BUSINESS ESTABLISHED:13. CURRENT MANAGEMENT SINCE:14.

BUSINESS PROPERTY IS:

Owned Leased

15. AMOUNT OF ESTIMATED LOSS:

NUMBER OF EMPLOYEES (pre-disaster):

If unknown, enter a question mark

16.

Name of Insurance Company and Agent

Phone Number of Insurance Agent

DAMAGED PROPERTY ADDRESS(ES)

Same as mailing address(If you need more space, attach additional sheets.)

INSURANCE COVERAGE (IF ANY)

Policy NumberSBA Form 5 (01-12) Ref SOP 50 30

Date Received _________ Location ________ By ____

Real Estate

Machinery & Equipment Leasehold Improvements

Inventory

12.

Coverage Type:(If you need more space, attach additional sheets.)

Apply online at https://disasterloan.sba.gov/ela/ OR send completed applications to:

U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, Texas 76155


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17. OWNERS(If you need more space attach additional sheets.)

Legal Name Title/Office % Owned E-mail Address

SSN/EIN* Marital Status Date of Birth* Place of Birth* Telephone Number (area code )

Mailing Address City State Zip

Legal Name Title/Office % Owned E-mail Address

SSN/EIN* Marital Status Date of Birth* Place of Birth* Telephone Number (area code)

Mailing Address City State Zip

* For information about these questions, see the attached Statements Required by Laws and Executive Orders.

18.

a. Has the business or a listed owner ever been involved in a bankruptcy or insolvency proceeding? . . . . . . . . . . . . . . . . . . . . . . Yes No

b. Does the business or a listed owner have any outstanding judgments, tax liens, or pending lawsuits against them? . . . . . . . . . . Yes Noc.

Yes No

d. Has the business or a listed owner ever had or guaranteed a Federal loan or a Federally guaranteed loan? . . . . . . . . . . . . . . . Yes Noe.

Yes No

f.

Yes No

g.Yes No

19. Regarding you or any joint applicant listed in Item 17:

Has the business or a listed owner ever been convicted of a criminal offense committed during and in connection with a riot

or civil disorder or ever been engaged in the production or distribution of any product or service that has been determined to

be obscene by a court of competent jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Is the business or a listed owner delinquent on any Federal taxes, direct or guaranteed Federal loans (SBA, FHA, VA,

student, etc.), Federal contracts, Federal grants, or any child support payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Does any owner, owner's spouse, or household member work for SBA or serve as a member of SBA's SCORE, ACE, or

Advisory Council? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a) have you ever been or are you presently, under indictment or subject to a criminal investigation or have you otherwise been charged through a

judical process of having committed a crime; b) have you been arrested or arraigned in the past six months; c) have you ever been convicted ,

plead guilty to a crime, plead nolo contendere to a crime, placed on pretrial diversion, or placed on any form of parole or probation -- including

adjudication withheld pending probation -- for an criminal offense other than a minor vehicle violation?

Is the applicant or any listed owner currently suspended or debarred from contracting with the Federal government or receiving

Federal grants or loans? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For the applicant business and each owner listed in item 17, please respond to the following questions, providing dates and details on anyquestion answered YES (Attach an additional sheet for detailed responses).

Complete for each: 1) proprietor, or 2) limited partner who owns 20% or more interest and each

general partner, or 3) stockholder or entity owning 20% or more voting stock.

Yes No

20.

21.

NO

AGREEMENTS AND CERTIFICATIONSOn behalf of the undersigned individually and for the applicant business:

(Signature of Individual) (Print Individual Name)

(Name of Company)

Street Address, City, State, Zip

Phone Number (include Area Code)

Fee Charged or Agreed Upon

Unless the NO box is checked, I give permission for SBA to discuss any portion of this application with the representative listed above.

PHYSICAL DAMAGE LOANS ONLY. If your application is approved, you may be eligible for additional funds to cover the cost ofmitigating

measures (real property improvements or devices to minimize or protect against future damage from the same type of disaster event).

It is not necessary for you to submit the description and cost estimates with the application. SBA must approve the mitigating measuresbefore any loan increase. By checking this box, I am interested in having SBA consider this increase.

Name and Address of Representative (please include the individual name and their company)

If anyone assisted you in completing this application, whether you pay a fee for this service or not, that person must print and sign their name

in the space below.

If yes, Name:

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SIGNATURE TITLE DATESign in Ink

(Individuals and businesses.)

US Citizen

Yes No

NoYes

US Citizen

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Business Entity OwnerName

Type of Business % Ownership

Mailing Address City State Zip Code

EIN

E-mail Address Phone


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U. S. Small Business Administration

DISASTER BUSINESS LOAN APPLICATION

If you have questions about this application or problems providing the required information, please contact our Customer

Service Center at 1-800-659-2955 or [email protected]

If more space is needed for any section of this application, please attach additional sheets.

SBA will contact you by phone or E-mail to discuss your loan request.

Filing Requirements

FOR ALL APPLICATIONS THE FOLLOWING ITEMS MUST BE SUBMITTED.

ADDITIONAL REQUIREMENTS FOR MILITARY RESERVIST ECONOMIC INJURY

(MREIDL);

This application (SBA Form 5), completed and signed

Complete copies, including all schedules, of the most recent Federal income tax returns for the applicant business; an

explanation if not available

Personal Financial Statement (SBA Form 413) completed, signed, and dated by the applicant (if a sole proprietorship),

each principal owning 20 percent or more of the applicant business, and each general partner or managing member

Schedule of Liabilities listing all fixed debts (SBA Form 2202 may be used)

A copy of the essential employees notice of expected call-up to active duty, or official call-up orders, or

release/discharge from active duty

A written explanation and financial estimate of how the call-up of the essential employee has or will result in

economic injury to your business, and the steps your business is taking to alleviate the economic injury

Your statement that the reservist is essential to the successful day-to-day operations of the business

Your certification that the essential employee will be offered the same or a similar job upon the employees

return from active duty

The essential employees concurrence with your statements

MREIDL Certification Form P-0002, which includes:

Complete copy, including all schedules, of the most recent Federal income tax return for each principal owning

20 percent or more, each general partner or managing member, and each affiliate

A current year-to-date profit-and-loss statement

ADDITIONAL INFORMATION MAY BE NECESSARY TO PROCESS YOUR

APPLICATION. IF REQUESTED, PLEASE PROVIDE WITHIN 7 DAYS OF THE

INFORMATION REQUEST;

Tax Information Authorization (IRS Form 8821), completed and signed by each applicant, each principal owning

20 percent or more of the applicant business, each general partner or managing member, and each affiliate business.

Affiliates include, but are not limited to, business parents, subsidiaries, and/or other businesses with common ownership

or management

If the most recent Federal income tax return has not been filed, a year-end profit-and-loss statement and balance

sheet for that tax year

Additional Filing Requirements (SBA Form 1368) providing monthly sales figures


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The Privacy Act authorizes SBA to make certain "routine uses" of information protected by that Act. One such routine use for SBA's

loan system of records is that when this information indicates a violation or potential violation of law, whether civil, criminal, or

administrative in nature, SBA may refer it to the appropriate agency, whether Federal, State, local or foreign, charged with responsi

for or otherwise involved in investigation, prosecution, enforcement or prevention of such violations. Another routine use of perso

information is to assist in obtaining credit bureau reports, on the Disaster Loan Applicants and guarantors for purposes of originatin

servicing, and liquidating Disaster loans. See, 69 F.R. 58598, 58617 (and as amended from time to time) for additional background a

other routine uses.

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disaster business loan application sba

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