FOR PROFIT BUSINESS LOAN APPLICATION
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If you need help with any part of this submission, please feel free to contact CEDF during regular business hours at (203) 235-2333 x2001 or lending@CEDF.com. You may save and complete your entries for later submission. Save button is at the bottom of the form.
If a loan officer has provided you with a product code, please type it here, otherwise leave blank.
Amount Requested $
Purpose of the Loan
Collateral Description
Organization Type
Please Select
C-Corporation
S- Corporation
LLC
General Partnership
Sole Proprietorship
Other
Legally Registered Company Name
Trade or DBA Name
Primary Contact
Title
Registered Address with Sec. of State
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Telephone
Number: (###) ###-####
Business
Cell
Residence
Website
Date Established
/
Month
/
Day
Year
Date
Federal Tax ID
Referred by
Please Select
Bank
Boost Fund
Small Business Support Organization
Individual and organization who referred you
Primary Bank Name
Gross Annual Revenue $
Total Business Debt $
No. of Current Full Time Employees
No. of Current Part Time Employees
No. of Projected Full Time Employees in one year based on successful funding
No. of Projected Part Time Employees in one year based on successful funding
Management Team
*
Owner #1 -- Owners/Principal Officers with 20% or more ownership
Owner #1 -- Demographics - Race (Please check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to respond
Owner #1 -- Ethnicity
Please Select
Hispanic
Not Hispanic
Prefer not to respond
Owner #1 -- Veteran Status
Please Select
Veteran
Service disabled veteran
Prefer not to respond
Owner #1 -- Additional Information
Yes
No
Do you consider yourself a person with a disability?
Have you ever been declared bankrupt?
Have you ever defaulted on any loans?
Do you have any outstanding liens, suits or judgments?
Are you delinquent on any child support, alimony, student loan or government payments?
Have you ever been indicted for a felony?
Are you currently on parole?
Owner #1 -- If you know your credit score, what is it?
Owner #1 -- Do you take a draw from the business? Indicate amount and frequency
Add Additional Owner
Owner #2 -- Owners/Principal Officers with 20% or more ownership
Owner #2 -- Demographics - Race (Please check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to respond
Owner #2 -- Ethnicity
Please Select
Hispanic
Not Hispanic
Prefer not to respond
Owner #2 -- Veteran Status
Please Select
Veteran
Service disabled veteran
Prefer not to respond
Additional Information: Owner #2
Yes
No
Do you consider yourself a person with a disability?
Have you ever been declared bankrupt?
Have you ever defaulted on any loans?
Do you have any outstanding liens, suits or judgments?
Are you delinquent on any child support, alimony, student loan or government payments?
Have you ever been indicted for a felony?
Are you currently on parole?
Owner #2 -- If you know your credit score, what is it?
Owner #2 -- Do you take a draw from the business? Indicate amount and frequency
Add a Third Additional Owner
Owner #3 -- Owners/Principal Officers with 20% or more ownership
Owner #3 -- Demographics - Race (Please check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to respond
Owner #3 -- Ethnicity
Please Select
Hispanic
Not Hispanic
Prefer not to respond
Owner #3 -- Veteran Status
Please Select
Veteran
Service disabled veteran
Prefer not to respond
Additional Information: Owner #3
Yes
No
Do you consider yourself a person with a disability?
Have you ever been declared bankrupt?
Have you ever defaulted on any loans?
Do you have any outstanding liens, suits or judgments?
Are you delinquent on any child support, alimony, student loan or government payments?
Have you ever been indicted for a felony?
Are you currently on parole?
Owner #3 -- If you know your credit score, what is it?
Owner #3 -- Do you take a draw from the business? Indicate amount and frequency
Project Sources and Use of Funds
Where will you get the money? List all your sources.
*
How will you spend the money?
*
Business financial data provided below is as of:
-
Month
-
Day
Year
Date
Assets (Show each applicable type. Show total in last row.)
*
Liabilities (Show each applicable type. Show total in last row.)
*
Net Worth (Assets minus Liabilities)
Income / Expenses (Show for each line item. Show Net Income in last row.)
*
Existing Business Debt
*
Delinquent Business Taxes if Any
*
Agreement to Apply
THE UNDERSIGNED CERTIFIES THAT THE INFORMATION PROVIDED HAS BEEN CAREFULLY READ AND IS TRUE, CORRECT AND COMPLETE. THE UNDERSIGNED FURTHER REPRESENTS THAT THERE ARE NOT ENCUMBRANCES AGAINST ANY OF THE FOREGOING PROPERTY EXCEPT THOSE SPECIFICALLY DISCLOSED ABOVE. COMMUNITY ECONOMIC DEVELOPMENT FUND (CEDF) IS AUTHORIZED TO VERIFY THE INFORMATION DISCLOSED AND TO PERFORM A CREDIT INVESTIGATION AND BANK TRANSACTION ANALYSIS. CEDF RESERVES THE RIGHT TO ORDER CREDIT REPORTS AND/OR UPDATES OF BANK TRANSACTION ANALYSES AT ANY TIME BETWEEN THE DATE BELOW AND IF CREDIT IS GRANTED, UNTIL THE LOAN IS FULLY PAID OFF. THE UNDERSIGNED AUTHORIZES CEDF, IF CREDIT GRANTED, TO GIVE CREDIT INFORMATION TO ANY CREDIT REPORTING SERVICE AND TO ADVISE OTHERS ABOUT ITS CREDIT EXPERIENCE WITH YOU. IT IS ALSO AGREED THAT THE FINANCIAL STATEMENT SHALL REMAIN THE PROPERTY OF CEDF WHETHER OR NOT CREDIT IS GRANTED. NOTICE: This program may be partially funded by the U.S. Small Business Administration (SBA). SBA’s funding is not an endorsement of any products, opinions or services. All SBA funded programs are extended to the public on a non-discriminatory basis. You are advised that the Community Economic Development Fund (the “CEDF”) may constitute a “public agency for purposes of the Connecticut Freedom of Information Act (the “Act”). All commercial or financial information provided to CEDF in connection with a loan application or an outstanding loan shall be considered “given in conference” as provided in the Act. CEDF will use reasonable efforts to protect any such information given in confidence from public disclosure. If you need help with any part of the loan process, please feel free to contact CEDF at (203) 235-2333 or toll-free (888) 835-2333. The information contained in this application is true to the best of my knowledge,and is being given for consideration of credit by CEDF.
By its (title)
(Signature)
Date
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Month
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Day
Year
Date
By its (title)
(Signature)
Date
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Month
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Please verify that you are human
*
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