Business Name*
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Business Address*
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First name*
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Last name*
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Is this contact an owner with 20% equity or more?*
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Business phone*
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Cell phone*
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Email address*
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Rent or Own Business Property?*
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Monthly Rent/Mortgage*
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EIN/SSN*
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Date Business Established*
Primary Industry*
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Ownership Structure*
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If Other, please specify
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
Last year gross sales*
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Last year net earnings*
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Number of Employees (Full Time Equivalent)*
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Monthly fixed expenses*
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Reason and Purpose for Loan*
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Amount Requested*
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Is the Business physically located in Millcreek Township, PA?*
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Does the Business owner have their primary residence located in Erie County, PA?*
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Have you been in continuous operation since March 1, 2017?*
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Is the Business able to demonstrate economic hardship of a loss of revenue of 25% or more in FY 2020 compared to FY 2019?*
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Has the Business been in operation and in compliance with State and County health codes?*
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Have you filed for bankruptcy within the past ten (10) years?*
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Are there any outstanding judgments entered against you?*
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Are you presently a party to any lawsuits?*
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Are there any local, state or federal tax liens filed against you?*
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Are you current with all local, state, and federal taxes?*
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Are all permits and licenses issued by the Township current and active?*
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Are there outstanding code violations at the business location or issued to the owner of the business?*
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Please provide W-9. (Please make sure you fill out appropriate fields and SIGN YOUR W-9)*
Please provide Articles of Incorporation or other state documentation verifying business entity structure.*
Please provide driver’s license for all owners.*
Please provide 2019 Business Tax Returns.*
Please provide 2020 Business tax returns or statement of financials if not yet complete.*
Signature. (By signing this application, you are authorizing ECRDA to verify your personal credit)*
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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.*
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I also understand that all loans are subject to a $375.00 lender fee which will include the UCC-1 filing fee.*
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I also understand All loans must be secured with a personal guarantee from the applicant in addition to the general guaranty and suretyship agreement.*
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I also understand that all applications will become property of Millcreek Township and the Erie County Redevelopment Authority, and all applications are subject to the Pennsylvania Open Records Act, provided that the Township and Authority will use its best efforts to maintain the confidentiality of any confidential financial information submitted, as permitted by law.*
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Please verify that you are a real person*