Form SBA Form 700 SBA Form 700 Home and Business Loan Inquiry Record

PLEASE NOTE: The public reporting burden for this collection of information is estimated to average 15 minutes per response, including gathering
and maintaining the data needed, and completing and reviewing the collection of information. You are not required to respond to any collection of
information unless it displays a currently valid OMB Approval number. Send comments regarding this burden estimate or any other aspect of this
collection of information including suggestions for reducing this burden to: Chief, AIB, Room 5000, U.S. Small Business Administration, Washington,
DC 20416; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
U.S. Small Business Administration

OMB No. 3245-0084

DISASTER BUSINESS LOAN INQUIRY RECORD
1. NAME OF PROSPECTIVE APPLICANT
Legal name
Trade name

2. SSN OF APPLICANT:

3. FEMA REGISTRATION NUMBER:

4. MAILING ADDRESS
number

street

city

county

state

zip

city

county

state

zip

5. BUSINESS LOCATION, if different
number

street

6. TELEPHONE at place of business
area code

7. TELEPHONE OF ALTERNATIVE CONTACT
Name

number

area code

number

8. TYPE OF BUSINESS ACTIVITY

9. TYPE OF ORGANIZATION
Sole proprietorship

Partnership

Corporation

Other: ________________________________________

10. INQUIRER
Name
If not applicant, relationship to applicant
mailing address, if different from applicant’s
telephone number, if different from applicant’s

11. APPLICATION REQUESTED
in individual in-person interview

in group in-person interview

by telephone interview

by mail

12. APPLICATION ISSUED
type:

physical

EIDL

method:

in-person on (date) _________________

by mail on (date) ________________

13. COMMENTS

14. INTERVIEWER
Signature

printed name

Location
SBA Form 700 (8-06) Ref. SOP 50-30

title

declaration number
Previous Editions Obsolete

date

PLEASE NOTE: The public reporting burden for this collection of information is estimated to average 15 minutes per response, including gathering and maintaining
the data needed, and completing and reviewing the collection of information. You are not required to respond to any collection of information unless it displays a
currently valid OMB Approval number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions
for reducing this burden to: Chief, AIB, Room 5000, U.S. Small Business Administration, Washington, DC 20416; and to the Office of Information and Regulatory
Affairs, Office of Management and Budget, Washington, DC 20503.
U.S. Small Business Administration

OMB No. 3245-0084

DISASTER HOME LOAN INQUIRY RECORD
1. NAME OF PROSPECTIVE APPLICANT (if Inquirer is not applicant, state inquirer’s 2. HOME TELEPHONE
Last

first

relationship to “A” in comments section.)
mi

3. SSN OF APPLICANT:

area code

number

4. FEMA REGISTRATION NUMBER:

5. MAILING ADDRESS
number

street

city

county

state

zip

state

zip

6. DAMAGED PROPERTY ADDRESS (If different from mailing address)
number

street

city

county

7. MARITAL STATUS OF PROSPECTIVE APPLICANT
married

separated

9. DEPENDENTS

Applicant Gross salary

Will spouse be a
joint applicant?

unmarried (single, divorced or widowed)

yes
no

10. INSURANCE COVERAGE FOR THIS LOSS?
yes
no

total number in family

11. GROSS INCOME

8. SPOUSE’S NAME

(NOTE: Alimony, child support or separate maintenance payments need not be disclosed if not a basis for
repayment for this loan request.)
Week
Week
OTHER income, gross (include
Source of OTHER income
joint applicant, if any)
Month
Month

$

$

year

year

12. DEBTS ---OTHER OBLIGATIONS:
name and address of creditor
mortgage or rent

Include alimony, child support, real estate taxes and insurance, etc.
monthly pmt
name and address of creditor

monthly pmt

$

$

$

$

$

$
Total

$

13. SIGNATURE OF APPLICANT
15. TYPE OF INTERVIEW
16. APPLICATION GIVEN?

DATE

Individual

Group

Yes on (date) _________

$

14. SIGNATURE OF JOINT APPLICANT

Telephone

18. SBA Use Only

No, provide comments

17. COMMENTS
Recommending Official (sign & print name)

Concurring Official (sign & print name)
Form 1363 given on date ___________________

19. INTERVIEWER
signature

location

printed name

title

declaration number

date

SBA Form 700 (8-06) Ref. SOP 50-30

Previous Editions Obsolete