Is this your 1st or 2nd Draw
First Draw
Second Draw
Previous PPP Loan Amount (If Applicable)
PPP Loan E-Tran Number (If Applicable)
PPP LOAN AGREEMENT ( If you received a prior loan)
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Cancel
of
Were you in business prior to January 31, 2020
Yes
No
PAYCHECK PROTECTION PROGRAM
Borrower Application Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Email Address
example@example.com
SOCIAL SECURITY NUMBER
DOB
-
Month
-
Day
Year
Date
Check One
Sole proprietor
Partnership
C-Corp
S-Corp
LLC
Independent contractor
Eligible self-employed individual
501(c)(3) nonprofit
501(c)(19) veterans organization
Tribal business (sec. 31(b)(2)(C) of Small Business Act)
Other
2019 Total Income
2020 Total Income
Valid ID Front And Back
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Cancel
of
Bank Statements Feb 2020
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Cancel
of
940/941 W-2 Payroll
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Cancel
of
VOIDED CHECK
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Cancel
of
Schedule C/ K1/1065
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Cancel
of
Is This a Personal or Business Account
Personal
Business
Routing Number
Account Number
Business Legal Name
*
What Type of Industry is Your Business?
What Date Was Your Business Establish
-
Month
-
Day
Year
Date
Business EIN
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone
-
Area Code
Phone Number
Primary Contact
-
Area Code
Phone Number
Email
example@example.com
Average Monthly Payroll:
Number of Employees ( Contractors or not direct employees)
x 2.5 + EIDL, Net of Advance (if Applicable) Equals Loan Request:
Applicant Ownership
List all owners of 20% or more of the equity of the Applicant. Attach a separate sheet if necessary.
1
Owner Name
Title
Ownership %
EIN
Address
1.
2.
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Next
Date
-
Month
-
Day
Year
Date
Print Name
First Name
Last Name
Title
Back
Next
Signature
Submit
Should be Empty: