Application Form

Application Form

All persons required to complete SBA Form 413 should be listed as applicants.

Identity of Applicant(s)

Applicants(Required)
Name
Street Address
City
State
Zip
County
Phone
 

Identity of the Business/Organization

Address(Required)

Ownership

Ownership (if a Corporation, indicate who is President and Secretary)(Required)
Name
Title
% Ownership
 

Primary Contact

Name(Required)
Address

Affiliate Businesses or Subsidiary Firms

Affiliate Businesses or Subsidary Firms
Business Name
Street Address
City
State
Zip
Phone
 

Existing Business Locations

Existing Business Locations
Street Address
City
State
Zip
Replaced by New Facility (Yes/No)
Sq. Feet
Annual Lease Payment
Lease Expire Date
 

Sources of Funds

List the total cost of the project together with all anticipated sources and amounts of project funds, including Recover NWI loan proceeds, bank financing, and owner cash. Your sum of Recover NWI loan proceeds and other fund sources must sum to the project total.

List
Source
Amount ($)
 

Job Retention and Creation

Max. file size: 256 MB.
Existing Jobs
Job Title
Avg Hourly Wage ($)
# of Jobs
Full-Time (Yes/No)
To Be Retained (Yes/No)
 
New Jobs Created
Job Title
Avg Hourly Wage ($)
# of Jobs
2021
2022
2023
Full-Time (Yes/No)
To Be Retained (Yes/No)
 

References

References should be a Banker, Accountant, and Attorney for your business.

References(Required)
Firm Name
Person's Name
Phone