Revolving Construction Loan Gap Funding Application

Revolving Construction Loan Gap Funding Application
BASIC INFORMATION

Please tell us about your business or organization.
Business or Organization Name
Who referred you to us?
Address

Street Address

Street Address Line 2

CityState

Zip Code
Type of Business
Date Started

MonthDayYear
Date
Federal Tax ID (if incorporated)
Today's Date

MonthDayYear
Date
Legal Structure (please check one)

C CorporationS CorporationNonprofit CorporationLimited Liability CorporationLegal PartnershipSole Proprietorship
Are you thinking about changing your legal structure?

YesNo
Contact Person
Who should we contact?
Business Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email
example@example.com
Number of Current Employees
How many jobs will this loan create?
Describe your business or organization and what you plan to do with this loan.
Please provide a brief description.
PROJECT INFORMATION

Please tell us about your project and/or start-up budget.
Uses of Funds
Land and/or Building Purchase
Provide amount in $
New Building Construction
Provide amount in $
Building Improvements
Provide amount in $
Machinery and Equipment
Provide amount in $
Inventory
Provide amount in $
Working Capital
Provide amount in $
Other
Provide amount in $
Other
Provide amount in $
Total of All Uses of Funds
Should equal all of the fields above.
Sources of Funds
Loan Requested
Provide amount in $
Owner's Investment
Provide amount in $
Other Funding Sources (specify)
Provide amount in $
Total of All Sources of Funds
Should equal all of the fields above.
COLLATERAL

Please tell us about the assets available to secure this loan.

Assets Information

	Value of Asset ($)	Loans on Asset ($)	Address of Asset
Property 1
Property 2
Inventory
Equipment
Accounts Receivables
Other (specify)

Name(s) of Possible CoSigner(s) for Loan Request
Separate names by commas
MANAGEMENT INFORMATION AND ACCKNOWLEDGMENTS

Please read the following and complete the information below.
The undersigned certifies that the information in this application and related materials is true and correct. The undersigned hereby further certifies that any loan proceeds made as a result of this application will be used for business or organizational purposes only and not for personal or consumer purposes. The undersigned hereby affirms that he or she does not discriminate based on race, color, religion, national origin, gender, marital status, or age. The undersigned hereby acknowledges that (1) no one has the authority to commit WeBuild Concord to any loan without prior approval by the Revolving Construction Loan Committee and the CEO of WeBuild Concord, and (2) any loan commitment must be in writing and signed by an authorized representative of WeBuild Concord. WeBuild Concord is authorized to make all inquiries WeBuild Concord deems necessary to verify the accuracy of this statement and todetermine the creditworthiness of the business or organization. The undersigned also authorizes WeBuild Concord to answer questions and inquiries from others seeking credit experience information about the business or organization.

Please provide this information for the Executive Director, Treasurer, and/or Board Chairperson.
Name
Ownership %
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Function
Signature

Clear
Date Signed
Name
Ownership %
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Function
Signature

Clear
Date Signed
Name
Ownership %
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Function
Signature

Clear
Date Signed
Please submit this application form and upload the required attachments to WeBuild Concord in PDF format to info@webuildconcord.org under the subject "Construction Loan" or mail to the office location below.

IMPORTANT: Please refer to the checklist of items necessary. Complete all paper forms and upload the additional documents. Your application CANNOT be processed without the inclusion of ALL required materials. If you have any questions about your application, please call the WeBuild Concord office.

WEBUILD CONCORD
4 Barbrick Ave SW, Suite 10
Concord, NC 28025

704.784.0039
Email Us
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Revolving Construction Loan Gap Funding Application

BASIC INFORMATION

PROJECT INFORMATION

Uses of Funds

Sources of Funds

COLLATERAL

MANAGEMENT INFORMATION AND ACCKNOWLEDGMENTS