WAUWATOSA REVOLVING LOAN FUND CORPORATION EMPLOYEE RETENTION SHORT TERM WORKING CAPITAL LOAN PROGRAM

Application Form

This program is available to for-profit small businesses located in the City of Wauwatosa. Please answer all application questions below.

In addition to this completed and submitted application form, you must submit the documentation listed below via e-mail to economicdevelopment@wauwatosa.net, with the subject line: WRLFC COVID-19 Loan Program - "Type Your Business's Name".

Required documents can be downloaded at www.wauwatosa.net/business.

·       Executed Affirmation verifying all eligibility criteria are met
·       Executed General Business Security Agreement
·       Executed personal guaranty of each substantial equity holder
·       Two most recent month’s payroll expense reports and other expense receipts to be covered by loan

· Additional documentation to verify eligibility may be required upon request

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* 1. Please provide the full legal name of your business:

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* 2. Business Owner Information

Last Name

First Name

E-mail

Business Phone Number

Best Contact Phone Number

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* 3. Business Owner's Mailing Address

Name

Street

City, State

Zip

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* 4. Business Address

Business Name

Street

City, State & Zip

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* 5. Do you own or rent your business property?

Own

Rent

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* 6. What type is your business? (e.g. restaurant, retail, salon, fitness, etc.)

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* 7. What is your business structure?

Sole Proprietorship

LLC

C-Corporation

S-Corporation

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* 8. Is there more than one business owner?

Yes

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* 9. If you answered yes to Question 8, please provide the name of each business owner and their percent ownership. If no, skip to Question 10.

Owner 2: First & Last Name

Owner 2: Percent (%) Ownership

Owner 3: First & Last Name

Owner 3: Percent (%) Ownership

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* 10. Does your business employ 50 or less employees, including yourself?

Yes

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* 11. Has your business been affected by COVID-19?

Yes

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* 12. What are the challenges your business is facing because of the COVID-19? (Check all that apply)

Payroll

Rent / Mortgage Payment

Vendor Payments

Utilities

Other (please specify)

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* 13. Please provide a brief explanation of the adverse economic impacts, resulting in at least a 25% decline in revenue, COVID-19 has had on your business (submission of financial documentation may be required, as determined to be appropriate by staff):

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* 14. How many people did you employ prior to COVID-19?

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* 15. How many people do you employ after COVID-19?

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* 16. What is the loan amount you are applying for? (amount not to exceed $20,000):

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* 17. How will you use these funds to help your business? Please include all business expenses, by type and amount, that you will pay with these funds.

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* 18. Do you have currently have insurance that covers your business and does it include business interruption insurance?

I currently have insurance coverage for my business

My business insurance includes business interruption coverage

I do not have insurance coverage for my business

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* 19. What was your business profitable in 2019?

Yes

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* 20. What was your average monthly revenue prior to impacts of COVID-19?

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* 21. What is your projected monthly revenue so long as the Wisconsin Department of Health Services Emergency Order #12 (“Safer At Home”), or any subsequent order which may impact your business in a similar manner, is in place?

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* 22. What was your average monthly payroll expense prior to impacts of COVID-19?

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* 23. What is your projected monthly payroll so long as the Wisconsin Department of Health Services Emergency Order #12 (“Safer At Home”), or any subsequent order which may impact your business in a similar manner, is in place?

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* 24. What is your monthly rent or mortgage payment?

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* 25. What is your average monthly utility expense?

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* 26. What are your average monthly business debt payments?

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* 27. How much existing debt does your business have?

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* 28. Do you owe any back taxes to the IRS, State of Wisconsin, or City of Wauwatosa?

Yes

If yes, are you on an approved payment installment plan?

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* 29. Do you owe any special assessments, fines, fees, etc. to the City of Wauwatosa?

Yes

If yes, are you on an approved payment installment plan?

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* 30. Do you have any outstanding City of Wauwatosa code compliance or other violations?

Yes

If yes, please specify

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* 31. Have you or your business ever filed for bankruptcy?

Yes

If yes, please provide brief explanation/detail

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* 32. Are you or your business currently involved in any lawsuits?

Yes

If yes, please provide a brief explanation

WAUWATOSA REVOLVING LOAN FUND CORPORATION EMPLOYEE RETENTION SHORT TERM WORKING CAPITAL LOAN PROGRAM

Application Form

Question Title

* 1. Please provide the full legal name of your business:

Question Title

* 2. Business Owner Information

Question Title

* 3. Business Owner's Mailing Address

Question Title

* 4. Business Address

Question Title

* 5. Do you own or rent your business property?

Question Title

* 6. What type is your business? (e.g. restaurant, retail, salon, fitness, etc.)

Question Title

* 7. What is your business structure?

Question Title

* 8. Is there more than one business owner?

Question Title

* 9. If you answered yes to Question 8, please provide the name of each business owner and their percent ownership. If no, skip to Question 10.

Question Title

* 10. Does your business employ 50 or less employees, including yourself?

Question Title

* 11. Has your business been affected by COVID-19?

Question Title

* 12. What are the challenges your business is facing because of the COVID-19? (Check all that apply)

Question Title

* 13. Please provide a brief explanation of the adverse economic impacts, resulting in at least a 25% decline in revenue, COVID-19 has had on your business (submission of financial documentation may be required, as determined to be appropriate by staff):

Question Title

* 14. How many people did you employ prior to COVID-19?

Question Title

* 15. How many people do you employ after COVID-19?

Question Title

* 16. What is the loan amount you are applying for? (amount not to exceed $20,000):

Question Title

* 17. How will you use these funds to help your business? Please include all business expenses, by type and amount, that you will pay with these funds.

Question Title

* 18. Do you have currently have insurance that covers your business and does it include business interruption insurance?

Question Title

* 19. What was your business profitable in 2019?

Question Title

* 20. What was your average monthly revenue prior to impacts of COVID-19?

Question Title

* 21. What is your projected monthly revenue so long as the Wisconsin Department of Health Services Emergency Order #12 (“Safer At Home”), or any subsequent order which may impact your business in a similar manner, is in place?

Question Title

* 22. What was your average monthly payroll expense prior to impacts of COVID-19?

Question Title

* 23. What is your projected monthly payroll so long as the Wisconsin Department of Health Services Emergency Order #12 (“Safer At Home”), or any subsequent order which may impact your business in a similar manner, is in place?

Question Title

* 24. What is your monthly rent or mortgage payment?

Question Title

* 25. What is your average monthly utility expense?

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* 26. What are your average monthly business debt payments?

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* 27. How much existing debt does your business have?

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* 28. Do you owe any back taxes to the IRS, State of Wisconsin, or City of Wauwatosa?

Question Title

* 29. Do you owe any special assessments, fines, fees, etc. to the City of Wauwatosa?

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* 30. Do you have any outstanding City of Wauwatosa code compliance or other violations?

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* 31. Have you or your business ever filed for bankruptcy?

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* 32. Are you or your business currently involved in any lawsuits?

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* 33. What other financial programs have you applied for to assist with impacts related to the COVID-19 pandemic?

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* 34. I attest, as the business owner completing this application, that all given application answers are accurate and truthful. (Type Name to Sign)