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Frederick County Small Business Loan Fund Application

Personal Information

Name:
Address:
Address:
Years There:
City/State/Zip: / /
Phone Number: (Where you can be reached)
Year last tax return filed:
Social Security #:
Date of Birth:
Email:

 

Employer Name & Address

Name:
Address:
Address:
Years There:
City/State/Zip: / /
Phone Number:

 

Business Information

Company Name:
Date started:
Any trade names: If so please list below.
 
Business Address:
Business Address:
City/State/Zip: / /
Business Phone No:
Tax ID#:
   
Business Type:
Select which most describes your business
Sole Proprietorship S Corp
C Corp LLC Partnership (Gen/Lim)
Other: (allows you to explain your business if it does not meet the above criteria)
   
  Are there any judgements, lawsuits or major disputes involving the business or the owners?    If yes, Please explain:
 
   
  Are all taxes current?    If No please explain:
 

 

Description of Business Product or Service

Manufacturing Wholesale
Retail Service
Import/Export Other (If Other)
 
 
Current Sales Level: $    as of what date?
 
Is the business seasonal? If Yes please identify seasonality:
 
No. of current employees: F/T:    P/T:
 
Please list all individuals with ownership:      
First and Last Name Citizen Title % Ownership
 
Company Legal Firm (Name, Contact Person & Phone #):
 
Company Accounting Firm (Name, Contact Person & Phone#):
 
Insurance Company (Name, Contact Person & Phone#):
 
Business Financial Institution (Name, Contact Person & Phone#):

 

Loan Information

Does the business currently have any loans?
If yes please describe:
 
Lender Name/Address/Phone:
 
Past Due?    Orig. Amount:
 
Current Balance:   Rate:
 
Collateral:

 

Loan Request Information

Amount:
 
Purpose:
 
Requested Loan Term:
 
Collateral Type:    Value:
 
Free of liens: If No please explain:
 
How did you hear about the Frederick County Small Business Loan Fund?
 
Checklist of Required Documents:
  • The Personal Financial Statement (Download a Personal Financial Statement template here) and the last 3 years of Tax Returns.
  • The Business Plan and 3 years of Financial Projections.
  • If you are an existing business, up to 3 years of historical financial statements.
  • The signed Release for a consumer credit check.
  • An established Economic development goal i.e. job creation, capital investment, other.
  • A nonrefundable loan application fee of $200.00. (Make checks payable to the Treasurer of Frederick County.)
  • Documents that establish business entity.
  • A valid utility bill will be required for proof of residency.
  • Certification of good standing from State Department of Assessments and Taxation.
  • All applicants/co-applicants must fill out Personal and Employer Information and sign release for consumer credit check.
  • Required documentation should be mailed or dropped off at the address below:
By submitting this application this is not an application to the loan fund but prequalification or counseling tool and for discussion purposes only.

I give permission to use this information without a signature.
 
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