Maui County Small Business Mortgage & Rent Relief (SBMRR) Direct Payment Program Application
Business Legal Name
*
Trade Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Email
*
example@example.com
Business Phone Number
*
Please enter a valid phone number.
Employer Identification Number
*
Hawaii Tax I.D. Number
*
Organization Type
*
Primary Contact Name
*
First Name
Last Name
Primary Contact Email (if different than business email)
*
example@example.com
Phone Number (if different than business phone number)
*
Please enter a valid phone number.
Please enter information for the business owner(s)
*
First & Last Name
Ownership %
Phone Number
Email Address
Owner 1
Owner 2
Owner 3
Owner 4
Owner 5
Owner 6
Owner 7
Owner 8
Owner 9
Owner 10
Date Business Established
*
-
Month
-
Day
Year
Date
Number of employees as of March 20, 2020
*
Number of employees as of the date of your application
*
2019 Gross Revenue
*
Select the Amount You Are Requesting: Businesses who employed 10 or more individuals (including owners) prior to COVID-19 and whose annual 2019 G49 shows revenues of between $1,500,000 and $4,000,000 may apply for up to $12,500. Businesses who employed 15 or more individuals (including owners) and whose 2019 annual G49 shows revenues of between $4,00,001 and $7,500,000 can apply for up to $25,000.
*
Up to $12,500
Up to $25,000
How much is your current monthly rent or mortgage?
*
If you have deferred or past due rent or mortgage payments, how much is currently owed?
*
Please explain how your business has been impacted by COVID-19 and your need for commercial rent or mortgage relief.
*
In the past year, has the business or a listed owner been convicted of a criminal offense committed during and in connection with a riot or civil disorder or other declared disaster, or ever been engaged in the production of any product or service that has been determined to be obscene by a court of competent jurisdiction?
*
Yes
No
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?
*
Yes
No
For any criminal offense - other than a minor vehicle violation - have you ever been convicted, plead guilty, please nolo contendere, been placed on pretrial diversion, or been placed on any form of parole or probation (including probation before judgement)?
*
Yes
No
Have you been arrested in the past 6 months for any criminal offense?
*
Yes
No
Please upload your business monthly or quarterly GET forms (G45) for January 2019-September 2019. *You may upload them together as 1 file or as separate documents.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your business monthly or quarterly GET forms (G45) for January 2020-September 2020. *You may upload them together as 1 file or as separate documents.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your business annual GET (G49) for 2019.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your 2019 business tax return.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload a statement of back owed commercial mortgage or commercial rent payments from your landlord or mortgage company (if applicable).
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
I hereby certify that I did not receive funding assistance from the Kokua Maui County Small Business Recovery & Relief Fund, the Maui County Adaptability Fund and/or the Maui Chamber of Commerce Micro Business Loan Program. I understand that I may simultaneously apply for other State and Federal funding programs, but no expense paid for under this program will be included in other applications. I have the authority to make this certification, and that all of the above information in this application is true and correct.
*
Submit
Should be Empty: