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Parkersburg Revolving Loan Fund Small Business Loan Application
Name of business
Business Address
City		State
Zip Code

Phone		Fax
E-mail

Is this a new business		If yes, intended start-up date
Type of business	Sole Proprietorship	Partnership	Corporation
Date established		Fed. I.D. #
State I.D. #

Name of owner #1		Percentage owned
Home address		SS#
City		State
Zip

Phone
Name of owner #2		Percentage owned
Home address		SS#
City		State
Zip

Phone
Name of bank		Branch
Bank address
City		State
Zip
Contact person		Account number

Project Information
What is the intended use of the loan funds?

Will additional jobs be created through this project	if yes, how many
Will any existing jobs be retained due to this project	if yes, how many
Brief description of your business:

Required Attachments
A. Business plan or current profit and loss statement
B. One of the following:
1. Signed personal financial statement(s) for persons listed on the application.
2. Federal income tax returns filed by the business for the past 3 years
C. Certificate of business compliance with all state laws affecting the conduct of business within the state.
D. Copy of signed purchase or lease agreement if purchasing or leasing property for business operation.
E. Statement from the applicant that the project could not be done without the financing of the Butler County Revolving Loan Fund.
F. Statement concerning the source of equity for the project, and how it will be obtained and appraised.
G. Support letter from your bank regarding any financing the bank will provide for this project.

Signatures:
I declare that any statement in this application and in it’s required attachments, or information provided herein, is true and complete in substance and fact.
By	Title	Date
Attest:	Title	Date

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