Business Name*
Business Address*
Owner Name/Primary Contact
First name*
Last name*
Email address*
Name of Owners with 20% equity or more
Owner 1
First name
Last name
Owner Address
Owner 2
First name
Last name
Owner Address
Owner 3
First name
Last name
Owner Address
Owner 4
First name
Last name
Owner Address
Business phone*
x
Cell phone*
Rent or Own Business Property?*
*
Monthly Rent/Mortgage*
EIN/SSN*
Date Business Established*
Primary Industry (NAICS)*
*
Ownership Structure*
*
If Other, please specify
Number of Employees (Full Time Equivalent)*
What type of loan are you requesting?*
*
Reason and Purpose for Loan*
Amount Requested*
Do you have collateral that can be used to secure this loan?*
*
If Yes, please list collateral that can be used to secure this loan
Please download the Income and Expense Report below. Complete both worksheets for personal and business income and expenses. Once completed, please upload the file for review.*
Click
Here to download the Income and Expense Report
Please provide driver’s license for all owners.*
Please provide a copy of your most recently filed taxes*
Please list any current loans/credit cards or debts*
Have you filed for bankruptcy within the last ten (10) years?*
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Are there any outstanding judgments entered against you?*
*
Are you presently a party to any lawsuits?*
*
Are there any local, state or federal tax liens filed against you?*
*
Are you current with all municipal services, i.e. water, sewer?*
*
Please indicate which represents you*
If Other, please specify
Are you current with all local, state, and federal taxes?*
*
I understand that making a false statement on this form is a violation of law and could result in criminal prosecution, significant civil penalties, and a denial of the loan.*
*
I am authorizing a credit bureau review*
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I understand a $50.00 application fee is required and my application will not be reviewed until fee is received.*
Checks should be made out to: "Erie County Redevelopment Authority" with "Microenterprise Fund Application" on the memo line.
Checks must be sent to:
Erie County Redevelopment Authority
ATTN: Ethan Bennett
1314 Griswold Plaza, Suite 200
Erie, PA 16501
*
Signature*
Please verify that you are a real person*