Paycheck Protection Program

New Borrower Application

First Draw

Second Draw

Business Type

Tax ID Type

Tax Identification Number

NAICS Code

Business Legal Name

Applicant First Name

Applicant Last Name

Applicable Size Standard

Doing Business As (dba)

Primary Contact Name

Primary Contact Email

Business Address

City

State

ZIP Code

Business Phone

Payroll

Lease / Mortgage Interest

Utilities

Operations Expenditures

Property Damage

Supplier Costs

Worker Protection Expenditures

Other (explain):

Average Monthly Payroll

Total Amount of Gross Income from Schedule C, line 7

Tax Year Used for Gross Income

Do you have employees other than owners?

Yes

A. Gross Income Amount from Schedule C, line 7, minus the sum of line 14, line 19, and line 26 A. Gross Income Amount from Schedule C, line 7

B. Divide A by 12 (max $8,333.33)

C. Average Monthly Payroll for Employees (not including owners)

EIDL Refinance Amount

EIDL Loan Number

Loan Request Amount

Loan request amount may not exceed average monthly payroll x2.5 + EIDL refinance amount

Loan request amount may not exceed average monthly payroll x2.5 (x3.5 for NAICS 72 applicants), in any case not to exceed $2,000,000

Loan request amount may not exceed the amount in box B x 2.5 + EIDL refinance amount Loan request amount may not exceed the amount in box B x 2.5 (x3.5 for NAICS 72 applicants), in any case not to exceed $2,000,000

Loan request amount may not exceed the amount in (box B plus box C) x 2.5 + EIDL refinance amount Loan request amount may not exceed the amount in (box B plus box C) x 2.5 (x3.5 for NAICS 72 applicants), in any case not to exceed $2,000,000

Business Established On

Number of Employees

PPP First Draw SBA Loan Number

PPP First Draw Loan Amount

Tax ID Type

Tax Identification Number

Ownership %

First Name

Last Name

Title

Address

City

State

ZIP Code

Remove

Note: If questions (1), (2), (5), or (6) are answered “Yes,” the loan will not be approved.

1. Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?

Yes

2. Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency that is (a) currently delinquent, or (b) has defaulted in the last 7 years and caused a loss to the government?

Yes

3. Is the Applicant or any owner of the Applicant an owner of any other business, or have common management (including a management agreement) with any other business?

Yes

If yes, list all such businesses (including their TINs if available) and describe the relationship.

4. Did the Applicant receive an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020?

Yes

If yes, provide details.

5. Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant presently incarcerated or, for any felony, presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?

Yes

6. Within the last 5 years, for any felony involving fraud, bribery, embezzlement, or a false statement in a loan application or an application for federal financial assistance, or within the last year, for any other felony, has the Applicant (if an individual) or any owner of the Applicant 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; or 4) commenced any form of parole or probation (including probation before judgment)?

Yes

7. Is the United States the principal place of residence for all employees included in the Applicant’s payroll calculation above? (If this question is answered "No," the loan will not be approved).

Yes

Is the Applicant a Franchise?

Yes

Has the Lender directly contracted with a third party to assist in the preparation of the loan application or application materials, or to perform other services in connection with this loan?

Yes

Color photo of drivers license (front side)

Color photo of drivers license (back side)

Bank Statement (Optional)

Voided Check (Optional)

Partnership Tax Schedules (Optional)

IRS W-3 (Optional)

Payroll Register or IRS 941 (Optional)

IRS Schedule C or IRS Schedule F (Optional)

Revenue Reduction Documents (Required for second draw PPP loans)

Maximum allowed document size is 33MB

By Signing Below, You Make the Following Representations, Authorizations, and Certifications

I certify that:

I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them.
The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the Small Business Administration (SBA) and the Department of the Treasury (Treasury) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and the Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act (the Paycheck Protection Program Rules).
The Applicant, together with its affiliates (if applicable), (1) is an independent contractor, self-employed individual, or sole proprietor with no employees; (2) if not a housing cooperative, eligible 501(c)(6) organization, or eligible destination marketing organization, employs no more than the greater of 500 employees or, if applicable, the size standard in number of employees established by SBA in 13 C.F.R. 121.201 for the Applicant’s industry; (3) if a housing cooperative, eligible 501(c)(6) organization, or eligible destination marketing organization, employs no more than 300 employees; (4) if NAICS 72, employs no more than 500 employees per physical location; (5) if a news organization that is majority owned or controlled by a NAICS code 511110 or 5151 business or a nonprofit public broadcasting entity with a trade or business under NAICS code 511110 or 5151, employs no more than 500 employees (or, if applicable, the size standard in number of employees established by SBA in 13 C.F.R. 121.201 for the Applicant’s industry) per location; or (6) is a small business under the applicable revenue-based size standard established by SBA in 13 C.F.R. 121.201 for the Applicant’s industry or under the SBA alternative size standard.
The Applicant, together with its affiliates (if applicable), (1) is an independent contractor, self-employed individual, or sole proprietor with no employees; (2) employs no more than 300 employees; or (3) if NAICS 72, employs no more than 300 employees per physical location; (4) if a news organization that is majority owned or controlled by a NAICS code 511110 or 5151 business or a nonprofit public broadcasting entity with a trade or business under NAICS code 511110 or 5151, employs no more than 300 employees per location.
I will comply, whenever applicable, with the civil rights and other limitations in this form.
All loan proceeds will be used only for business-related purposes as specified in the loan application and consistent with the Paycheck Protection Program Rules including the prohibition on using loan proceeds for lobbying activities and expenditures. If Applicant is a news organization that became eligible for a loan under Section 317 of the Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act, proceeds of the loan will be used to support expenses at the component of the business concern that produces or distributes locally focused or emergency information.
I understand that SBA encourages the purchase, to the extent feasible, of American-made equipment and products.
The Applicant is not engaged in any activity that is illegal under federal, state or local law.
Any EIDL loan received by the Applicant (Section 7(b)(2) of the Small Business Act) between January 31, 2020 and April 3, 2020 was for a purpose other than paying payroll costs and other allowable uses for loans under the Paycheck Protection Program Rules.

For Applicants who are individuals: I authorize the SBA to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.

The Applicant has certified to the Lender each of the following:

The Applicant was in operation on February 15, 2020, has not permanently closed, and was either an eligible self-employed individual, independent contractor, or sole proprietorship with no employees, or had employees for whom it paid salaries and payroll taxes or paid independent contractors, as reported on Form(s) 1099-MISC.
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
The funds will be used to retain workers and maintain payroll; or make payments for mortgage interest, rent, utilities, covered operations expenditures, covered property damage costs, covered supplier costs, and covered worker protection expenditures as specified under the Paycheck Protection Program Rules; I understand that if the funds are knowingly used for unauthorized purposes, the federal government may hold me legally liable, such as for charges of fraud.
The Applicant understands that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, covered rent payments, covered utilities, covered operations expenditures, covered property damage costs, covered supplier costs, and covered worker protection expenditures, and not more than 40% of the forgiven amount may be for non-payroll costs. If required, the Applicant will provide to the Lender and/or SBA documentation verifying the number of full-time equivalent employees on the Applicant’s payroll as well as the dollar amounts of eligible expenses for the covered period following this loan.
The Applicant has not and will not receive another loan under the Paycheck Protection Program, Section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36)) (this does not include Paycheck Protection Program second draw loans, Section 7(a)(37) of the Small Business Act (15 U.S.C. 636(a)(37)).

The Applicant has certified to the Lender each of the following:

The Applicant has not and will not receive a Shuttered Venue Operator grant from SBA.
The President, the Vice President, the head of an Executive department, or a Member of Congress, or the spouse of such person as determined under applicable common law, does not directly or indirectly hold a controlling interest in the Applicant, with such terms having the meanings provided in Section 322 of the Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act.
The Applicant is not an issuer, the securities of which are listed on an exchange registered as a national securities exchange under Section 6 of the Securities Exchange Act of 1934 (15 U.S.C. 78f).

The Applicant has certified to the Lender that the Applicant meets the revenue test and size standards described in this form.

The Applicant has certified to the Lender that the Applicant is eligible under the Paycheck Protection Program Rules.

I further certify that the information provided in this application and the information provided in all supporting documents and forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan from SBA is punishable under the law, including under 18 U.S.C. 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to $250,000; under 15 U.S.C. 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a federally insured institution, under 18 U.S.C. 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000.

I acknowledge that the Lender will confirm the eligible loan amount using required documents submitted. I understand, acknowledge, and agree that the Lender can share any tax information that I have provided with SBA’s authorized representatives, including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan Program Requirements and all SBA reviews.

Applicant Name

Applicant Title

Paycheck Protection Program

New Borrower Application

PPP Loan Type

Business Information

Purpose of the Loan

Loan Information

Reduction in Gross Receipts

Owner Information

Questions

Additional Questions

Documents

Certifications and Authorizations

Certifications

Signature