PROVIDING CAPITAL TO SMALL BUSINESSES

BUSINESS INFORMATION

Business Legal Name: *

Business DBA:

Amount Requested: $ *

Date Business was Established: *

Type of Business Entity: *

Number of Employees: *

Business Tax ID Number (no dashes): *

Type of Business Industry: *

State of Business Formation: *

NAICS Code:

Business Street Address: *

City, ST, Zip: *

Mailing Address (if different from Street Address):

City, ST, Zip:

Do you rent or own the location? *

How much do you pay in rent/mortgage for your commercial property? *

What is the fair market value of the combined assets of the business? *

Percentage of Business Ownership (for the Applicant) * 0 100

Average Annual Revenue *

Provide a brief description of the management team, time under current management, and depth of industry experience: *

Business Owner Street Address *

Business Owner City *

Business Owner State *

Business Owner ZIP Code *

Business Owner Name (Applicant): *

Business Owner Email Address: *

Your Credit Score (or best estimation): *

Business Phone Number: *

Business Owner Social Security Number (Number Only): *

Mobile Phone Number: *

Business Owner Date of Birth: *

Owner Place of Birth (City): *

Are you a US Citizen (US) or a Lawful Permanent Resident (LPR)? *

What is your marital status? *

Are you currently liable for any alimony payments, child support, or separate maintenance income? *

Do you rent or own your home? *

How much do you pay in rent/mortgage for your residential property? *

Total Outstanding Business Debt *

Do you have any felonies on your record? *

Does your business have any current Tax Liens? *

Average Monthly Balance (in your business account) *

Does the Applicant Business have any affiliates? (businesses with common ownership) *

Has the Applicant Business or its Affiliates ever filed for bankruptcy protection? *

Is the Applicant Business (or its affiliates) presently involved in any pending legal action? *

Has an application for the requested loan every been previously submitted to the SBA, a Lender, or a Certified Development Company, in connection with any SBA program? *

Has the Applicant (or its Affiliates) ever obtained a direct or guaranteed loan from the SBA or any other federal agency, OR been a guarantor on such a loan? *

If "Yes" to that previous question, did any of this financing ever default and cause a loss to the government? *

Is the Applicant presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency? *

Does the Applicant operate under a Franchise, License, Distributorship, Membership, Dealer, Jobber, or other type of agreement? *

Are any of the Applicant products or services exported, or will this loan result in exporting beginning? *

Are any of the Applicant Business' revenues derived from gambling, loan packaging, or from the sale of products, services, displays, or performances of a prurient sexual nature? *

Does this business lease or rent any equipment used in the day-to-day operations? *

How many Employees will be created/hired with the proceeds of this loan? *

Have you or any other Owner served in the military? *

How many Employees will be retained with the proceeds of this loan? *

Is there an SBA employee, or household member of an SBA employee, functioning as a sole proprietor, partner, officer, director, or stockholder with 10% (or greater) interest in the business? *

Is a former SBA employee, who has been separated from the SBA for less than one year prior to the request for financial assistance, an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant business? *

Is a member of Congress, or an appointed official or employee of the legislative or judicial branches of the federal government, a sole proprietor, general partner, officer, director, or stockholder with a 10% or greater interest, or a household member of such an individual, of the Applicant? *

Is a government employee having a grade of at least GS-13 or higher a sole proprietor, general partner, officer, director, or stockholder with a 10% or greater interest, or a household member of such an individual, of the Applicant? *

Is a member or employee of a Small Business Advisory Council or a SCORE volunteer a sole proprietor, general partner, officer, director, or stockholder with a 10% or greater interest, or a household member of such an individual, of the Applicant? *

Has the business ever received the ERC Credit? *

Business Ownership Breakdown (if you do not have multiple owners, you may skip this section)

Business Owner 2 Name *

Business Owner 2 Title *

Business Owner 2 Ownership Percentage *

Business Owner 2 TIN (SSN or EIN or ITIN) *

Business Owner 2 Street Address *

Business Owner 2 City *

Business Owner 2 ZIP *

Business Owner 2 State *

Business Owner 2 Date of Birth *

Business Owner 2 Email Address *

Business Owner 2 Estimated Credit Score *

Use of Funds

Real Estate or Land Purchase:

New Building Construction:

Business Acquisition:

Acquisition of Equipment:

Inventory Purchase:

Closing Costs:

Working Capital or Accounts Payable:

Building / Leasehold Improvements / Repairs/Renovations:

Total Funding:

If purchasing a business, please complete the following section, otherwise you may skip this part

Seller Business Name

Seller Business Street Address

Seller Business City :

Seller Business State

Seller Business ZIP

Is Real Estate included in the purchase?

Debt Schedule

Instructions:

Please only include debts that are in the business' name.
Please do not include personal debts, or debt taken out by an individual.
Please include all active EIDL or PPP loans.
Please include business credit cards and indicate in the Monthly Payment Amount how much is typically paid per month.
*all daily and weekly payment loans MUST be listed

Lender’s Name	Type of Debt	Original Amount	Current Balance	Interest Rate	Monthly Payment	Open Date	Maturity Date	Secured or Unsecured	Current or Delinquent	Type of Collateral

Terms & Conditions

Credit Authorization: By submitting this Application Form; Business Applicant and each Individual (each a “Signer” and collectively “Signers”) represent, acknowledge and agree as follows: (i) Signer is authorized on behalf of the business and all Owners, whose name(s) you have entered above to initiate this pre-qualification process for credit, and (ii) all information you have provided is true, correct and complete and that you will notify us of changes to such information. Signer understands and agrees that Block Equity Group and its Affiliates are authorized to contact third parties to conduct background checks and other investigative reports and make credit report inquiries (including requesting business and personal credit bureau reports from credit reporting agencies and other sources). By signing below, you are further providing “written instructions” to Block Equity Group. and its Affiliates under the Fair Credit Reporting Act authorizing Block Equity Group. and its Affiliates to obtain information from your personal and business credit profile, as well as the personal credit profiles for Signer and all listed Owners, to conduct a qualification for credit in connection with your business. E-Sign Consent: You hereby consent that your electronic signature on agreements and documents has the same legal and moral effect as if you signed such agreements and documents in ink and will be deemed valid, authentic, enforceable and binding. Pursuant to law and regulations, you agree and acknowledge that all electronic communications delivered to you by Block Equity Group and its Affiliates (a) shall be given the same legal effect as signed paper communications, (b) shall be considered a “writing” or “in writing” and (c) shall be deemed for all purposes to have been “signed” and to constitute an “original” when printed from electronic files or records established and maintained in the normal course of business.

By Checking this box, I agree to the Terms & Conditions:

I Agree

Name of Borrower SIgning:

Today's Date:

SBA Application