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EIDL Loan Application Questionnare

Business Information

Business Owner Information

Individual Owner(s)

Complete for Each: a. Proprietor, or b. Limited partner or LLC member who

owns 20% or more interest and each general partner or managing member,

or c. Stockholder or entity owning 20% or more voting stock

Additional Information

On behalf the individuals completing this application.
 
If my/our loan is approved, additional information may be required prior to
loan closing. I/We will be advised in writing what information will be required
to obtain my/our loan funds.
 
 I/We hereby authorize the SBA to verify my/our
past and present employment information and salary history as needed to
process and service a disaster loan.
 
I/We authorize SBA, as required by the Privacy Act, to release any
information collected in connection with this application to Federal, state,
local, tribal or nonprofit organizations (e.g. Red Cross Salvation Army,
Mennonite Disaster Services, SBA Resource Partners) for the purpose of
assisting me with my/our SBA application, evaluating eligibility for additional
assistance, or notifying me of the availability of such assistance.
 
I/We will not exclude from participating in or deny the benefits of, or
otherwise subject to discrimination under any program or activity for which I/
we receive Federal financial assistance from SBA, any person on grounds of
age, color, handicap, marital status, national origin, race, religion, or sex.
 
I/We will report to the SBA Office of the Inspector General, Washington, DC
20416, any Federal employee who offers, in return for compensation of any
kind, to help get this loan approved. I/We have not paid anyone connected
with the Federal government for help in getting this loan.
 
CERTIFICATION AS TO TRUTHFUL INFORMATION:
 By signing this application,
you certify that all information in your application and submitted with your
application is true and correct to the best of your knowledge, and that you
will submit truthful information in the future.
 
WARNING: Whoever wrongfully misapplies the proceeds of an SBA disaster
loan shall be civilly liable to the Administrator in an amount equal to one-
and-one half times the original principal amount of the loan under 15 U.S.C.
636(b). In addition, any false statement or misrepresentation to SBA may
result in criminal, civil or administrative sanctions including, but not limited
to: 1) fines and imprisonment, or both, under 15 U.S.C. 645, 18 U.S.C. 1001,
18 U.S.C. 1014, 18 U.S.C. 1040, 18 U.S.C. 3571, and any other applicable
laws; 2) treble damages and civil penalties under the False Claims Act, 31
U.S.C. 3729; 3) double damages and civil penalties under the Program Fraud
Civil Remedies Act, 31 U.S.C. 3802; and 4) suspension and/or debarment
from all Federal procurement and non-procurement transactions. Statutory
fines may increase if amended by the Federal Civil Penalties Inflation
Adjustment Act Improvements Act of 2015.
 
I hereby certify UNDER PENALTY OF PERJURY UNDER THE LAWS
OF THE UNITED STATES that the above is true and correct.