Transylvania Fund Application | Mountain BizWorks

If you have questions about this form or the Transylvania County Emergency Bridge Loan Program, please e-mail us at jeremiah@mountainbizworks.org.

Initial Certifications

Is your business located in Transylvania County?*

Yes
No

Have you been in operation for at least 12 months?*

Yes
No

Can you demonstrate that COVID-19 caused at least a 25% decrease in revenue?*

You will be required to demonstrate a revenue decrease by providing documentation such as: point-of-sales reports, bank statements, quarterly sales tax filings, 2019 tax returns, or CPA-certified profit & loss statements.

Yes
No

Does your business employ 1-49 employees across all locations?*

Yes
No

Are there any tax liens or legal judgments against your business?*

Yes
No

Have you applied for an SBA Disaster Recovery loan?*

Yes
No, but I will be applying soon
No and I'm not currently planning to apply

What was the outcome of your SBA application?

Primary Applicant: Personal Information

Name*

First Last

Title (example: Owner)*

Your Ownership Percentage (%) in the Business

Please enter a number from 0 to 100.

Home Address*

Street Address City State ZIP Code

Home County (example: Transylvania)

Email*

Phone*

SSN or ITIN Number*

Demographic Information: The following information is required for program reporting and statistical monitoring. Your response to these questions will not affect consideration of your application.

Gender*

Race/Ethnicity*

Primary Language*

Date of Birth*

Current Military Status*

Co-Applicants

Note: Anyone with 20% or more ownership in the business MUST be a co-applicant.

Are there any co-applicants?*

Yes
No

List all additional applicants:*

Please list one applicant per line and include Name, Title, Email, and Ownership % for each.

The Business

Business Name*

Include DBA if applicable

Business Description

Please provide a one-sentence description or "elevator-pitch" for your business. (max 250 chars.)

Business Mailing Address

Business mailing address is same as my home address

Business Mailing Address*

Street Address City State ZIP Code

Business Physical Address

Physical address is same as mailing address

Business Physical Address*

Street Address City State ZIP Code

Business County (example: Transylvania)

Year Started*

Example: 2017

Legal Status*

Tax ID / Federal EIN*

Number of full time staff*

Number of part time staff*

The Loan Request

How much money are you applying for?*

(must be between $2500 and $10,000)

Please enter a number from 2500 to 10000.

Use of Funds*

Please describe how the requested funds will be used to keep your business operating during these challenging times. (max. 500 characters)

Impacts, Resilience, & Adaptation*

How has COVID-19 impacted your business? What are you doing to help the business weather the crisis, and especially, in what ways are you adapting to the interim environment to do business in new or different ways? (max. 500 characters)

Are there any other services you need?

2019 Year End & Most Current Financials

Please provide a 2019 year-end Balance Sheet and Income Statement as well as a 2020 year-to-date Balance Sheet and Income Statement. (NOTE: if you run into technical issues uploading files, please submit the form without them and email them immediately to jeremiah@mountainbizworks.org. Please include All In Jackson Fund Docs in the subject line. Thank you.)

Drop files here or

Max. file size: 24 MB.

Hidden

Most Recent Tax Return

Please attach your most recent business tax return. For Sole Proprietorship, provide Form 1040, US Individual Income Tax Return, Sch. C, Profit or Loss from Business. For Partnership, provide Form 1065, U.S. Return of Partnership Income, Schedule K-1, Partners Share of Income,Deductions and Credits.

Drop files here or

Max. file size: 24 MB.

Additional Documentation for COVID-19 Impacts

If additional documents are need to demonstrate a COVID-19 caused decline in revenue of 25% or greater please attach those here. Examples include point-of-sales reports, bank statements, quarterly sales tax filings, 2019 tax returns, or additional profit & loss statements.

Drop files here or

Max. file size: 24 MB.

Agree to Share Economic Impact*

I agree to track and report when requested on economic impact achieved as a result of the program, including but not limited to, jobs created, jobs retained, increased sales, and access to capital.

I agree

Authorization & Certification*

I (the Primary Applicant) hereby authorize the Mountain BizWorks to make all inquiries with credit bureaus and others it deems necessary –including business counselors, consultants and partnering agencies—to verify the accuracy of the information provided herein and to determine credit worthiness. Further, I certify that all of the information submitted in this application is valid, accurate and complete. A photographic or facsimile copy of this authorization may be deemed to be equivalent of the original.

I agree to and affirm the above statement.