COVID-19 ECONOMIC INJURY DISASTER LOAN APPLICATIONS PPP/SBA EIDL
Eligible Entity Verification
STREAMLINED PROCESS REQUIREMENTS
SBA is collecting the requested information in order to make a loan under SBA’s Economic Injury Disaster Loan Program to the qualified entities listed in this application that are impacted by the Coronavirus (COVID-19). The information will be used in determining whether the applicant is eligible for an economic injury loan. If you do not submit all the information requested, your loan cannot be fully processed. The Applicant understands that the SBA is relying upon the self-certifications contained in this application to verify that the Applicant is an eligible entity, and that the Applicant is providing this self-certification under penalty of perjury pursuant to 28 U.S.C. 1746 for verification purposes. The estimated time for completing this entire application is two hours and ten minutes, although you may not need to complete all parts. You are not required to respond to this collection of information unless it displays a currently valid OMB approval number.
Choose Oneof the Following:
Applicant is a business with not more than 500 employees. Applicantis an individual who operates under a sole proprietorship, with or withoutemployees, or as an independent contractor. Applicant is a cooperative with not more than 500 employees. Applicant is an Employee Stock Ownership Plan (ESOP), asdefined in 15 U.S.C. 632, with not more than 500 employees. Applicant is a tribal small business concern, as describedin 15 U.S.C. 657a(b)(2)(C), with not more than 500 employees. Applicantis a business, including an agricultural cooperative, aquaculture enterprise,nursery, or producer cooperative, that is small under SBA Size Standards. Applicant is a business with more than 500 employees that issmall under SBA Size Standards. Applicant is a private non-profit organization that is anon-governmental agency or entity that currently has an effective ruling letterfrom the IRS granting tax exemption under sections 501(c),(d), or (e) of theInternal Revenue Code of 1954, or satisfactory evidence from the State that thenon-revenue producing organization or entity is a non-profit one organized ordoing business under State law, or a faith-based organization.
Review and Check All of the Following: Applicant must review and check all the following:*
Applicant is not engaged in any illegal activity (as defined by Federal guidelines). No principal of the Applicant with a 50 percent or greater ownership interest is more than sixty (60) days delinquent on child support obligations. Applicant is not an agricultural enterprise (e.g., farm), other than an aquaculture enterprise, agricultural cooperative, or nursery. Applicant does not present live performances of a prurient sexual nature or derive directly or indirectly more than de minimis gross revenue through the sale of products or services, or the presentation of any depictions or displays, of a prurient sexual nature. Applicant does not derive more thanone-third of gross annual revenue from legal gambling activities. Applicant is not in the business of lobbying. Applicant cannot be a state, local,or municipal government entity and cannot be a member of Congress.
Business Information
Business Legal Name*
Trade Name*
EIN/SSN for Sole Proprietorship*
Organization Type*
Gross Revenues for the Twelve (12) Month Prior to the Date of the Disaster*
Cost of Goods Sold for the Twelve (12) Month Prior to the Date of the Disaster*
Primary Business Address (Cannot be P.O. Box)*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
County
Business Phone Number
Area Code Phone Number
Alternative Business Phone Number
Area Code Phone Number
Business Fax
Area Code Phone Number
Business Email
Date Business Established
Current Ownership Since
Business Activity*
Number of Employees (As of January 31, 2020)
Business Owners Information
Individual Owner/Agents
Owner/Agent 1*
First Name Last Name
Mobile Phone*
Area Code Phone Number
Title / Office*
Ownership Percent*
Email*
example@example.com
SSN*
Birth Date*
Month Day Year
Date
Place of Birth*
Residential Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Additional Information
Should be Empty:

COVID-19 ECONOMIC INJURY DISASTER LOAN APPLICATIONS PPP/SBA EIDL

Business Information

Business Owners Information

Individual Owner/Agents

Additional Information