CEII Small Business Loan Application Form

CEII Small Business Loan Application

Personal Information SBA Loan Sequence #___________
Name of Applicant*

PrefixFirst NameMiddle NameLast Name
Business Name*
SSN :*
Tax Payer ID / EIN # (if available):
E-mail of Applicant*
Verify your email address
Business Website
Phone number of Applicant

Area CodePhone Number
Mobile Phone number of Applicant

Area CodePhone Number
Fax Number of Applicant

Area CodePhone Number
Address of Applicant*

Street Address

Street Address Line 2

CityState

Zip Code
Please select the County (Florida or Alabama) that the business is located (or will be) in. NOTE: - CEII services area includes the following counties in Florida/Alabama only.*
Alabama: Select the County that the business is located (or will be) in. NOTE: CEII service includes the following counties in Alabama only.
Date of Birth of Applicant*

MonthDayYear

CEII Small Business Loan Application

Project Details
Applying as*

Sole ProprietorPartnershipCorporationL.L.C.S. Corporation
Business Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employment Information: Please report as Full-Time Equivalent by counting part-time employees as a fraction of a full-time employee and then add to the total of all full-time employees. (For example, a part time employee who works half as many hours as a full-time employee is counted as .5)
Number of current employees:
Expected new hires (0-12 Months)
Expected new hires (13-24 months)
Will this loan allow you to retain employees?

YesNo
Expected number of jobs retained:
Are you a new or start-up business? (In business less than 2 years)

YesNo
How long have you been in business?

CEII Small Business Loan Application

Principal Owners
Name (1):
Title:
Ownership %:
Name (2):
Title:
Ownership %:
Name (3):
Title:
Ownership %:

CEII Small Business Loan Application

Loan Information
Loan Amount Requested*
Have you applied to a Bank or another financial organization for this loan?*

YesNo
NOTE: If applying for the SBA Microloan, the S.B.A. No Credit Elsewhere Test requires that all loan requests above $25,000 must have been declined by another lender. Proof of loan decline by another lender will be required to be submitted during the loan application process.
Bank/Financial Organization Name:
Lender Name:
Have you been declined by a Bank?

YesNo
Reason for decline:
Use of Funds

Please describe how the loan funds will be utilized based upon the categories below, including dollar ($) amount and description.
Equipment
Inventory
Leasehold Improvements
Working Capital
Other

Loan Collateral:

Please list all assets that you plan to pledge as collateral for this loan. CEII is a secured lender and requires personal or business collateral to be pledged as security for small business loans. For more information please visit our website at: http://www.ceii-cdc.org/sba-microloans

Business Loan Application

Business Debts
Are all business obligations current (including payroll, rent, taxes, etc.)?

YesNo
Is your business location leased

Yes
Project Marketing Material

Upload a File

Cancelof
Landlord Name:
Landlord Phone:
Do you own your business location?

YesNo
If yes, please provide the name(s) on the deed:
Date Purchased: $
Purchase Price: $
Mortgage Balance: $
Monthly Mortgage Payment: $
Annual Real Estate Tax: $
Mortgage Maturity Date:
Mortgage Holder:

Authorizations
The undersigned affirms that he/she is providing this information to support his/her financing request. The undersigned understands that Community Enterprise Investments, Inc., is relying on this information for the financing request, and hereby represents that this information is true, correct and complete. The undersigned will provide notice of any material adverse change in his/her financial condition including in his/her ability to perform under his/her obligations to Community Enterprise Investments, Incorporated. The undersigned authorizes Community Enterprise Investments, Inc., to answer questions and/or provide credit information to credit reporting agencies and other parties.

Furthermore, the undersigned acknowledges that he/she read and understands the above statement and voluntarily consents to the release of information in an ongoing basis throughout the underwriting process, unless this authorization is revoked by the undersigned. Such revocation may be exercised by the undersigned at any time except after the information has already been released by Community Enterprise Investments Inc.

The undersigned herein releases Community Enterprise Investments Inc., its Board of Directors, any employee, independent contractor, consultant and staff; and holds harmless from all legal responsibility or liability that might arise from this disclosure.

Business Loan Application

Submit my Application
The information provided in this application shall not be shared to anyone else and is kept confidential
I agree that the information herein are true and correct

Yes
Signature*

Clear

Should be Empty: