Form Business 3245-0018 Business 3245-0018 Business Loan Electronic Screen

Disaster Business Loan Application

ELA Business Screen 3245-0018

Additional Filing Requirements EIDL and MREIDL

OMB: 3245-0017

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3245-0017 can be found here:

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U.S. Small Business Administration
Electronic Disaster Loan Application

Federal Disaster Loans for Homeowners,
Renters, and Businesses of all Sizes
Continue

Business 3245-0018

09/12/2008

Page 1 of 126

What is the SBA Disaster Loan Program?
In the wake of hurricanes, floods, earthquakes, wildfires, tornadoes and other
disasters, the SBA is the primary source of money from the Federal government for
long-term recovery assistance. For disaster damage to private property owned by
individuals, families and businesses not fully covered by insurance, the basic form
of Federal assistance is low-interest, long-term disaster loans from the SBA.
Property owners usually have some insurance coverage, but often it does not cover
all losses or even the type of hazard, which caused the damage. This leaves
individuals and businesses with significant uninsured costs.
Most people cannot afford to pay for expensive disaster repairs out-of-pocket.
SBA disaster loans make recovery possible for the majority of borrowers.

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Welcome to SBA's Electronic Loan Application (ELA)
• The recommended browser for this site is Internet Explorer 6.0 or later.
• The first step in the ELA process is to register as a user of the SBA disaster
assistance site. At the end of the registration process, you will be asked to accept
our Statements Required By Laws and Executive Orders. Once you accept them,
a 10 digit Reference Number will appear at the bottom of the screen. Record
this number for future correspondence with the SBA or if you need to return to
complete your application. If you exit the system before accepting the Statements
Required By Laws and Executive Orders, you information will not be saved and you
will need to start a new application.
• If you have already completed an application and received a decision on your
application or your application has been withdrawn, please do not apply again.
Contact our Customer Service Center at (800) 659-2955. Customers with speech
or hearing disabilities may phone (800) 877-8339.

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Navigating the ELA
• For each screen, if you do not enter all the required information or the information you enter is not in
the correct format, you will not be able to go to the next screen. We will display a message in red to
identify missing information or format errors. You must enter the missing information and correct
errors to continue.
• After you complete each screen, select Next to continue.
• To go back, select Previous. If you have not completed the section, the ELA will take you back one
screen at a time.
If you select Previous the information you entered on the current screen will
be lost. You only lose information on the current screen.
• Do NOT use the Back and Forward navigation buttons on the tool bar of your Internet browser.
Always use Next and Previous to move from screen to screen. Using the Back and Forward buttons
will likely cause an application error. If an application error occurs, you must exit the ELA and log in
again.
• You can exit the ELA at any time by selecting the Exit button. When you select Exit, your session
closes properly, your data is saved, and you are logged out of the ELA.

Important Note: Do Not select the X in the upper right-hand corner of the screen to exit. If you select the
X to close the browser, your session will not be properly closed and you will not be able to log back in for
another 15 minutes.
In order to print documents from the ELA, you will need Adobe Reader. If you do not have Adobe Reader
installed on your computer, please click here to install Adobe Reader free.
If you need additional assistance on completing the ELA, select the help button at any time to guide you
through the process.

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* Do you accept the terms of use?
I Accept
I Do Not Accept

Are you a registered user of the SBA Disaster Assistance
Account Site?
Yes, I am a registered user on the SBA Disaster Assistance Account Site.
No, I'm a new user.

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Home/Personal Property Loan Application

Business Loan Application

Filing Requirements - Business
Identity Information
-Employer Identification Number (EIN) for the applicant business and any affiliate businesses
-Social Security Number for all principals/owners owning 20% or more of the business

Mortgage or Lease Information
-Mortgage holder's name, address and telephone number
-Landlord's name, address and telephone number
Insurance Information - Coverage for This Loss, if available
-Insurance policy (declaration page)
-Settlement information
-If you do not have your insurance policy or settlement information, you may be asked to provide the
name, address and telephone number of your insurance agent
Financial Information
-Copy of the applicant's 3 most recent Federal Income Tax Returns, including all schedules, if
available. If this is a new business that has not filed 3 Federal Tax Returns, we will need the ones
you have filed, if available.
-Copies of all principals/owners' (with 20% or greater ownership) most recently filed Federal Income
Tax Returns, if available
-For each principal/owner (with 20% or greater ownership), current bank statements, investment
mortgage information, business and farm records, stocks and bonds, and other investment records
-The business' current profit and loss statements and balance sheets, if available

Debt Information (principals/owners with 20% or greater ownership)
-Creditors' names (include all mortgages, credit cards, installment loans, personal loans, vehicle
loans)
-Monthly payments
-Balances owed
Debt Information (applicant business), if available
-Creditors' names, original amount, original date, current balance, maturity date, payment amount,
and security
Miscellaneous Information (for the applicant business, each principal/owner with 20% or
greater ownership), if available
-Account information on existing direct or guaranteed Federal and SBA loans
-Details on delinquent taxes
-Details on bankruptcies
-Details on any outstanding judgments and pending lawsuits
For sole proprietors, your alien registration or permanent residence card (if you are not a U.S.
citizen)
For Military Reservist Economic Injury Disaster Loans (MREIDL) only
-Name and Social Security Number of essential employee called to active duty
-Date called to active duty, if known
-Date released / discharged from active duty, if released / discharged
*In a disaster declared by the President, all disaster victims should
register with FEMA by calling (800) 621-3362 ), or (800) 462-7585 for people
with speech or hearing disabilities.
Based on the information you provide, we will generate a list of additional
filing requirements necessary for us to process your application.
Print

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Website Registration * Indicates Required Field
* First Name

* Last Name

* Social Security Number

Suffix

* Date of Birth
MM/DD/YYYY

###-##-####

Address
Street

* Street #

Post Office Box

Rural Route

* Street Name

Suffix

* Street Type

Unit/Suite/Number

Address Line 2
* City

* State

Phone Number (landline)

* Zip Code

Cell Phone Number

* County
E-Mail Address

YOU MUST ENTER A PHONE NUMBER ABOVE FOR THE AUTHENTICATION METHOD YOU
HAVE SELECTED!

Please select an authentication method below. Authentication methods are how we
make sure that no one else is using your identity to access your account. We will send
you a pass code - a special code you enter to gain access.
* Pass Code Delivery Method
Text message Delivery to Cell Phone
We will send a pass code to your cell phone. (Your cell phone must support SMS text messaging)
Voice Delivery to Home Phone
The system will call you on your landline telephone and read a pass code to you.
Voice Delivery to Cell Phone
The system will call you on your cell phone and read a pass code to you.

*Create Your User Name (Must be at least 6 characters)
Your User Name does not meet the requirements for User
Name format. Please try again.
Must be at least 8 characters and must contain at least three of the
*Create Your Password following items: one uppercase letter, one lower case letter, one number,
one special character from this list ! @ # $ % ^ & * ( ) _ + - = [ ] { } \ | ; :
‘“,.<>/?

*Confirm Password
Your passwords must match

Your password does not meet the requirements for passw
Please try again.
Your passwords do not match. Please try again.

* Security Question 1
What school did you attend for sixth grade?

* Security Answer 1

* Security Question 2
On what street was your first house?

* Security Answer 2

* Please type the text appearing in the image below:
Note: If you cannot view the image for any reason, please click on the speaker icon to hear the
code. Then enter the code in the box below.

Your entry does not match the image. Please try again.

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Website Registration * Indicates Required Field
* First Name

* Last Name

* Social Security Number

Suffix

* Date of Birth
MM/DD/YYYY

###-##-####

Address
Street

Post Office Box

Postal Type

Rural Route

* Box Number

Address Line 2
* City

* State

Phone Number (landline)

* Zip Code

Cell Phone Number

* County
E-Mail Address

YOU MUST ENTER A PHONE NUMBER ABOVE FOR THE AUTHENTICATION METHOD YOU
HAVE SELECTED!

*Create Your User Name (Must be at least 6 characters)
Your User Name does not meet the requirements for User
Name format. Please try again.
(Must be at least 8 characters and must contain at least three of the
*Create Your Password following items: one uppercase letter, one lower case letter, one number,
one special character from this list ! @ # $ % ^ & * ( ) _ + - = [ ] { } \ | ; :
‘“,.<>/?

*Confirm Password
Your passwords must match

Your password does not meet the requirements for passw
Please try again.
Your passwords do not match. Please try again.

* Security Question 1
What school did you attend for sixth grade?

* Security Answer 1

* Security Question 2
On what street was your first house?

* Security Answer 2

* Please type the text appearing in the image below:
Note: If you cannot view the image for any reason, please click on the speaker icon to hear the
code. Then enter the code in the box below.

Your entry does not match the image. Please try again.

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Website Registration * Indicates Required Field
If you are applying for a business, please register as an individual.

* First Name

* Last Name

Suffix

* Date of Birth

* Social Security Number

MM/DD/YYYY

###-##-####

Address
Street

Post Office Box

* Number

Rural Route

Box

Rural Route
Address Line 2
* City

* State

Phone Number (landline)

* Zip Code

Cell Phone Number

* County
E-Mail Address

YOU MUST ENTER A PHONE NUMBER ABOVE FOR THE AUTHENTICATION METHOD YOU
HAVE SELECTED!

*Confirm Password
Your passwords must match

Your password does not meet the requirements for passw
Please try again.
Your passwords do not match. Please try again.

* Security Question 1
What school did you attend for sixth grade?

* Security Answer 1

* Security Question 2
On what street was your first house?

* Security Answer 2

* Please type the text appearing in the image below:
Note: If you cannot view the image for any reason, please click on the speaker icon to hear the
code. Then enter the code in the box below.

Your entry does not match the image. Please try again.

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We cannot confirm your identity. Please contact our Customer Service
Center at (800) 659-2955 or (800) 877-8339 for people with speech or hearing
disabilities.

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Please enter your User Name and Password
Invalid User Name or Password. Please try again.
* User Name
* Password

Don't remember your Password?

After you have logged in, you may change your password or update your User Profile by
selecting the check boxes below .
Change Password

Update User Profile

You have logged in using a temporary password. Please create a new
password below. Remember, your new password must be at least 8
characters and must contain at least three of the following items: one
uppercase letter, one lower case letter, one number, one special character from
this list ! @ # $ % ^ & * ( ) _ + - = [ ] { } \ | ; : ‘ “ , . < > / ?
*Create New Password
Your password does not meet the requirements for
password format. Please try again.
*Confirm New Password
Your passwords do not match. Please try again.
Your passwords must match

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Please enter your User Name and Password
Invalid User Name or Password. Please try again.
* User Name
* Password

Don't remember your Password?

After you have logged in, you may change your password or update your User Profile by
selecting the check boxes below .
Change Password

Update User Profile

Your password has expired. Please create a new password below.
Remember, your new password must be at least 8 characters and must contain
at least three of the following items: one uppercase letter, one lower case letter,
one number, one special character from this list
!@ # $ % ^ & * ( ) _ + - = [ ] { } \ | ; : ‘ “ , . < > / ?
*Create New Password
Your password does not meet the requirements for
password format. Please try again.
*Confirm New Password
Your passwords do not match. Please try again.
Your passwords must match

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Please create your new password below. Remember, your new password
must be at least 8 characters and must contain at least three of the following
items: one uppercase letter, one lower case letter, one number, one special
character from this list
!@ # $ % ^ & * ( ) _ + - = [ ] { } \| ; : ‘“ ,. < > / ?
* Old Password
* New Password

Your passwords do not match.
Please try again.

* Confirm New Password

Reminder: Your new password will be valid for 90 days.

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User Profile
You may update any of the fields below except for your security question. When you have
completed your update, answer the security question then click the NEXT button.

Street

* Street #

Post Office Box

Rural Route

* Street Name

Suffix

* Street Type

Unit/Suite/Number

Address Line 2

City

Zip Code

State

Phone Number (landline)

Cell Phone Number

* County

E-Mail Address

Pass Code Delivery Method
Text message Delivery to Cell Phone
We will send a pass code to your cell phone. (Your cell phone must support SMS text messaging)
Voice Delivery to Home Phone
The system will call you on your landline telephone and read a pass code to you.
Voice Delivery to Cell Phone
The system will call you on your cell phone and read a pass code to you.

Secret Question

System randomly generated

* Secret Answer

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User Profile
You may update any of the fields below except for your security question. When you have
completed your update, answer the security question then click the NEXT button.

Street

Post Office Box

Postal Type

Rural Route

* Box Number

Address Line 2

City

Zip Code

State

Phone Number (landline)

Cell Phone Number

* County

E-Mail Address

Secret Question

System randomly generated

* Secret Answer

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User Profile
You may update any of the fields below except for your security question. When you have
completed your update, answer the security question then click the NEXT button.

Street

Post Office Box

* Number

Rural Route

Box

Rural Route
Address Line 2

City

Zip Code

State

Phone Number (landline)

Cell Phone Number

* County

E-Mail Address

Secret Question

System randomly generated

* Secret Answer

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If you do not remember your password please
answer the following question:
User Name
Secret Question
* Secret Answer

ENTER

E-Mail Address
Your password will be e-mailed to you once you click
the ENTER button.

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U.S. Small Business Administration
Electronic Disaster Loan Application

Federal Disaster Loans for Homeowners,
Renters, and Businesses of all Sizes
Apply for a Home /
Personal Property Loan

Apply for a Business /
Rental Property Loan

Continue An Existing
Application
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Select the application you would like to
complete
Select Reference Number

Loan Type

Applicant Name

Date Last Updated

1000000000

Home

Doe, John J

Last Update Date 1

1000000001

Business

Doe, Randy L

Last Update Date 2

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Business Losses
* Is the applicant business a Non Profit organization?
Yes
No
* What type of damage did you suffer? (check all that apply)
Real Property (Including Leasehold Improvements)
Business Contents (Machinery & Equipment, Furniture &
Fixtures, and Other Business Assets)
Inventory
Economic Injury Disaster Loan (EIDL)
Military Reservist Economic Injury Disaster Loan (MREIDL)

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You are requesting the following assistance
Non Profit Organization
Real Property (Including Leasehold Improvements)
Business Contents (Machinery & Equipment, Furniture and Fixtures,
and Other Business Assets)
Business - Inventory
Economic Injury Disaster Loan (EIDL)
Military Reservist Economic Injury Disaster Loan (MREIDL)

Is this correct?
Yes
No

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Enter your FEMA Registration Number, if you have one.
If you do not have a FEMA Registration Number please select
the state where the disaster occurred.
State

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We have not received your information from FEMA. You can continue
by selecting the state where the disaster occurred.
State

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The FEMA registration number you entered
is associated with the declaration listed
below.
State

California

County

Orange

* Is this correct?

Disaster Description

Tornado, Severe Storms

Disaster Date

05/20/2008

Yes
No

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Select the disaster that affected you
* County
State - State
* Active Disaster Declarations
Select Disaster Name

County where the damage occurred.
Disaster Description

Disaster Date

Disaster Name 1

Disaster Description 1

Incident Start Date 1

Disaster Name 2

Disaster Description 2

Incident Start Date 1

If you do not see the disaster that affected you, you may change the county where the
disaster damage occurred or please contact our Customer Service Center at (800) 659-2955
or (800) 877-8339 for people with speech or hearing disabilities.

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* STATEMENTS REQUIRED BY LAW AND
EXECUTIVE ORDERS

I accept
I do not accept

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I acknowledge that making materially false statements in this application is a crime
under federal law, punishable by fines of up to $250,000 and up to 30 years in prison,
under the following statues: 18 U.S.C. § 1040 (30 years), 18 U.S.C. § 1001 (5 years),
and 15 U.S.C. § 645 (2 years). I further acknowledge that if my loan is approved, at the
closing, I will be asked to sign a copy of this application certifying under penalty of
criminal prosecution that all information and documentation that I have provided is
truthful and accurate.

*I Acknowledge
Yes
No

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In this section we ask you about the applicant(s)
To complete this section, you will need the following information
• Employer Identification Number (EIN) for the applicant business and any
affiliate businesses
• Social Security Number for all principals/owners owning 20% or more of the
business

Business 3245-0018

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What type of business organization do you own?
* Organization Type Help Link to IRS
Sole-Proprietor (including individuals with rentals)

Corporation

Partnership

Non-Profit Organization

Limited Partnership

Trust

Limited Liability Entity

* First Name of Owner

* Last Name of Owner

Business Trade Name
Social Security Number *
Primary Business Activity (Provide a brief description of your business)

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What type of business organization do you own?
* Organization Type Help Link to IRS
Sole-Proprietor (including individuals with rentals)

Corporation

Partnership

Non-Profit Organization

Limited Partnership

Trust

Limited Liability Entity

* Legal Name of Business
Business Trade Name
Employer Identification Number * (EIN)
Primary Business Activity (Provide a brief description of your business)

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What type of business organization do you own?
* Organization Type Help Link to IRS
Sole-Proprietor (including individuals with rentals)

Corporation

Partnership

Non-Profit Organization

Limited Partnership

Trust

Limited Liability Entity

* Legal Name of Trust
Employer Identification Number * (EIN)

Primary Business Activity (Provide a brief description of your business)

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Current Business Mailing Address
Street

* Street #

Rural Route

Post Office Box

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
* City

* Zip Code

* State

* County

* Business Phone Number Alternate Phone Number
Does the applicant business own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

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Current Business Mailing Address
Street

Rural Route

Post Office Box

Postal Type

* Box Number

Address Line 2
* City

* County

* Zip Code

* State

* Business Phone Number Alternate Phone Number
Does the applicant business own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

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Current Business Mailing Address
Street

Rural Route

Post Office Box

* Number

Box

Rural Route
Address Line 2
* City

* County

* Zip Code

* State

* Business Phone Number Alternate Phone Number
Does the applicant business own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

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Business Name

Month

Year

Year Business Established

(YYYY)

Under Current Management Since

(YYYY)

Business Annual Gross Revenue
Less than $100,000
$100,001 - $ 500,000
$ 500,001 - $1,000,000
$1,000,001 - $5,000,000
Greater than $5,000,000
Number of Employees

(Prior to the disaster)

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Primary Applicant
ABC Corp

Organization Type

(System Generated)

Corporation (System Generated)

Edit

List any:
1) Ownership that is 20% or greater, regardless if ownership is by an Individual or
business entity.
2) List ALL family members who are owners regardless of percentage owned.
3) General Partner (Partnership, Limited Partnership)
4) Principal(s) of Non Profit Organization (Must Provide at least one principal)
Click "Enter Details" to complete the owner/principal information. After the owner information is complete, you will return to
this screen to select another owner to enter details or you may select the radio button next to the owner you wish to Edit or
Delete.

* Name of Owner(s)

* % owned

* Type of Ownership

John J Doe

20%

Principal (Non Profit)

Jane Doe

20%

Individual

ABC Network

20%

Business

John Smith

20%

Individual

Harry Smith

20%

Individual

Edit Delete

Enter Details

Add Owner
Total

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Current Management/Ownership - Individual
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

% Ownership % Ownership

Marital Status

SSN *

Date of Birth

Place of Birth

(MM/DD/YYYY)

* Mailing Address
* Street # * Street Name

Street

Post Office

Rural Route

* Street Type

Same as Applicant Business

Suffix

Unit/Suite/Number

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 38 of 126

Current Management/Ownership - Individual
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

% Ownership % Ownership

Marital Status

SSN *

Date of Birth

Place of Birth

(MM/DD/YYYY)
Street

* Mailing Address
Postal Type

Post Office

Rural Route

Same as Applicant Business

* Box Number

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 39 of 126

Current Management/Ownership - Individual
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

% Ownership % Ownership

Marital Status

SSN *

Date of Birth

Place of Birth

(MM/DD/YYYY)
Street
* Mailing Address
* Number Box
Rural Route

Post Office

Rural Route

Same as Applicant Business

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 40 of 126

Principal / Officer
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

SSN *

Marital Status

Place of Birth

Date of Birth (MM/DD/YYYY)
* Mailing Address
* Street # * Street Name

Street

Post Office

Rural Route

* Street Type

Same as Applicant Business

Suffix

Unit/Suite/Number

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 41 of 126

Principal / Officer
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

SSN *

Marital Status

Place of Birth

Date of Birth (MM/DD/YYYY)
Street

* Mailing Address
Postal Type

Post Office

Rural Route

Same as Applicant Business

* Box Number

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 42 of 126

Principal / Officer
John Doe
Prefix
* First Name

Middle Initial

* Last Name

Suffix

Title/Office

SSN *

Marital Status

Place of Birth

Date of Birth (MM/DD/YYYY)
Street
* Mailing Address
* Number Box
Rural Route

Post Office

Rural Route

Same as Business

Address Line 2
* City

* Zip Code

* State

* Current Phone Number

* County

Alternate Phone Number

E-mail Address
Does this owner/principal own 20% or more of a corporation, partnership,
limited partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 43 of 126

Current Management/Ownership

Entity Name

* Legal Name
* Type Of Business

% of Ownership % Ownership

Employer Identification Number * (EIN)
* Mailing Address
* Street # * Street Name

Street

Post Office

Rural Route

* Street Type

Same as Applicant Business

Suffix

Unit/Suite/Number

Address Line 2
* City

* Zip Code

* State

* County

Contact Information
* Name
* Phone Number
Title/Office
E-mail Address
Does this business own 20% or more of a corporation, partnership, limited
partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 44 of 126

Current Management/Ownership

Entity Name

* Legal Name
* Type Of Business

% of Ownership % Ownership

Employer Identification Number * (EIN)
Street
* Mailing Address
Postal Type
* Box Number

Post Office

Rural Route

Same as Applicant Business

Address Line 2
* City

* Zip Code

* State

* County

Contact Information
* Name
* Phone Number
Title/Office
E-mail Address
Does this business own 20% or more of a corporation, partnership, limited
partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 45 of 126

Current Management/Ownership

Entity Name

* Legal Name
* Type Of Business

% of Ownership % Ownership

Employer Identification Number * (EIN)
Street

* Mailing Address
* Number

Post Office

Rural Route

Same as Applicant Business

Box

Rural Route
Address Line 2
* City

* Zip Code

* State

* County

Contact Information
* Name
* Phone Number
Title/Office
E-mail Address
Does this business own 20% or more of a corporation, partnership, limited
partnership, or LLC?
Yes
No
* Business Name

City

* EIN

State

Type

Zip Code

% Owned

Add Another

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 46 of 126

In this section we ask you about your damages and recoveries
To complete this section, you will need the following information
Insurance policy (declaration page), if available
If you do not have your insurance policy or settlement information, you may
be asked to provide the name, address and telephone number of your
insurance agent
Claim settlement information, if available

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 47 of 126

In this section we ask you about your damages and recoveries
To complete this section, you will need the following information
Name and Social Security Number of essential employee called to active duty
Date called to active duty (if known)
Date released / discharged from active duty (if released / discharged)

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 48 of 126

DISASTER LOAN APPLICATION

Disaster Damaged Property Summary
Select "Add" next to the topic you want to visit to begin entering information regarding your disaster damaged property.
When you are finished entering all of the information, select "Next" to continue. If you did suffer other damages, you may
add them to your application here. If you are unsure how to complete this screen, Please select help.

Real Estate, Business Contents & Inventory

Add

1923 Your Street, Dallas, TX 75248

Add

Insurance
Allstate Insurance - Business
Allstate Insurance - Flood
9821 My Street, Dallas, TX 75248

Add

Insurance
Allstate Insurance - Business
4453 Woodland Drive, Dallas, TX 75248

Add

Insurance
None

Edit

Delete

Edit

Delete

Edit

Delete

Economic Injury Disaster Loan (EIDL)
1923 Your Street, Dallas, TX 75248

Add

Insurance
Nationwide -

Business Interruption

Military Reservist Economic Injury Disaster Loan (MREIDL)
1923 Your Street, Dallas, TX 75248

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 49 of 126

Please provide the address of the disaster damaged property
Same as Mailing Address

Do you own or lease this property?
Street

* Street #

Own

Lease

Rural Route

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
* City

* State

* Zip Code

* County

Who should we contact to arrange for our on-site damage inspection?
* Name
* Phone Number

Who should we contact if we have questions about your application?
same as onsite inspection contact

Name
Phone Number

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 50 of 126

Please provide the address of the disaster damaged property
Same as Mailing Address

Do you own or lease this property?
Street

Own

Lease

Rural Route

* Number

Box

Rural Route
Address Line 2
* City

* State

* Zip Code

* County

Who should we contact to arrange for our on-site damage inspection?
* Name
* Phone Number

Who should we contact if we have questions about your application?
same as onsite inspection contact

Name
Phone Number

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 51 of 126

Please estimate the cost to repair or replace your
disaster damaged property
Real Estate/Leasehold
Improvements
Less Than $10,000
$10,000 - $50,000
$50,001 - $250,000
$250,001 - $500,000
$500,001 - $1,000,000
Greater than $1,000,000

Contents
Less Than $10,000
$10,000 - $50,000
$50,001 - $250,000
$250,001 - $500,000
$500,001 - $1,000,000
Greater than $1,000,000

Inventory
Less Than $10,000
$10,000 - $50,000
$50,001 - $250,000
$250,001 - $500,000
$500,001 - $1,000,000
Greater than $1,000,000

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 52 of 126

Did you have insurance coverage for your disaster
damaged property?
Yes
No

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 53 of 126

Insurance Policy Information
Type
* Insurance Company
Agent
Agent's Phone Number
Agent's Address
Street

* Street #

Post Office Box

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
City

State

Zip Code

Policy Number
Claim Number
Real Estate

Contents

Inventory

Bus Interruption

Policy Limit
Deductible
Pending

Settlement Amount
Amount Received

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 54 of 126

Insurance Policy Information
Type
* Insurance Company
Agent
Agent's Phone Number
Agent's Address
Street

Post Office Box

Postal Type

Box Number

Address Line 2
City

State

Zip Code

Policy Number
Claim Number
Real Estate

Contents

Inventory

Bus Interruption

Policy Limit
Deductible
Pending

Settlement Amount
Amount Received

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 55 of 126

Note Regarding Insurance
SBA disaster loans are available for the amount of the disaster-related
damages, LESS any insurance recoveries and assistance from other
disaster relief agencies.
It is not necessary that you settle with your insurance company before
you apply for an SBA disaster loan. If your claim is questioned or
otherwise delayed, we can loan the full amount of the damages so you
can begin repairs. The insurance settlement is then assigned to us to
reduce the loan once the settlement is received.

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 56 of 126

Economic Injury
Do you think your business will return to normal operations within 60
days of the date of the disaster?
Yes
No

Please provide a brief explanation of the economic loss
caused by the declared disaster. Include an explanation of
how the loan funds would be used.

When do you anticipate your business will return to normal operations?
(MM/YYYY)

Date

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 57 of 126

Please provide a brief explanation of the economic loss caused by the declared
disaster. Include an explanation of how the loan funds would be used.

When do you anticipate your business will return to normal operations?
Date

(MM/YYYY)

Physical address where the economic injury occurred:
Same as Mailing Address

* Street #

Street

* Street Name

Rural Route

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
* City

* State

* Zip Code

* County

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 58 of 126

Please provide a brief explanation of the economic loss caused by the declared
disaster. Include an explanation of how the loan funds would be used.

When do you anticipate your business will return to normal operations?
Date

(MM/YYYY)

Physical address where the economic injury occurred:
Same as Mailing Address

Street

* Number

Rural Route

Box

Rural Route
Address Line 2
* City

* State

* Zip Code

* County

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 59 of 126

Insurance Policy Information
Type

Business Interruption

* Insurance Company
Agent
Agent's Phone Number
Agent's Address
Street

* Street #

Post Office Box

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
City

State

Zip Code

Policy Number
Claim Number
Business Interruption
Policy Limit
Deductible
Settlement Amount

Pending

Amount Received

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 60 of 126

Insurance Policy Information
Type

Business Interruption

* Insurance Company
Agent
Agent's Phone Number
Agent's Address
Street

Post Office Box

Postal Type

Box Number

Address Line 2
City

State

Zip Code

Policy Number
Claim Number
Business Interruption
Policy Limit
Deductible
Settlement Amount

Pending

Amount Received

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 61 of 126

Please provide the details below of the essential employee
* First Name

Middle Name

* Last Name

* Social Security Number

Date Ordered to Active Duty (if known)

Date Released / Discharged From Active
Duty (if released / discharged)

(MM/DD/YYYY)

? Help

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 62 of 126

In this section we ask you about your financial information
Business Financial information
SBA will need the following financial information from the applicant business, owners that are
legal entities (Corporation, LLC, etc), and any businesses that the owner or applicant
business may own in order to complete the processing of the disaster loan application:
1. A current Income (Profit & Loss) Statement, dated within the past 90 days.
2. A current Balance Sheet, dated within the last 90 days.
3. A Schedule of Liabilities. This is a listing of creditors that the applicant business owes
money to and how much is paid a month/year.
4. A Monthly Sales document, reporting the gross sales the applicant business received
each month for the past 3 years and the current year to date. The total of each year should tie
to the amount reported on the Federal Income Tax Return for the years supplied.

Business 3245-0018

? Help

09/12/2008

Exit

Page 63 of 126

Gross Income (Pre-Disaster)
Please check all sources of income for Applicant/Principal
Wages/Salary
Trust
Pension
Social Security/Disability
Interest/Dividends

Distributions From Retirement Accounts
Alimony
Child Support
Schedule C Business (income from individual business)
Schedule E Business (rents, royalties, K1 income)
Schedule F Business (farm or ranch income)

Other (Examples of OTHER income are regular part-time work, commissions, living
allowance, transportation allowance, and similar items.)

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 64 of 126

Wages/Salary

John Doe

*Employer's Name
Address
Street

* Street #

Post Office Box

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
City

Zip Code

State

* Phone Number
Length of Employment * Years
* Title

* Months

* Occupation

* Supervisor's Name
* Gross Income
Previous

* Frequency

(pre-disaster)

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 65 of 126

Wages/Salary

John Doe

*Employer's Name
Address
Post Office Box

Street

Postal Type

Box Number

Address Line 2
City

Zip Code

State

* Phone Number
Length of Employment * Years
* Title

* Months

* Occupation

* Supervisor's Name
* Gross Income
Previous

* Frequency

(pre-disaster)

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 66 of 126

Other Income

John Doe
* Amount

* Frequency

Pension
Social Security/Disability
Interest / Dividends
Distributions From Retirement
Alimony
Child Support
Trust
Other - Description from
Financial - Income Sources

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 67 of 126

Schedule C Self Employment
Name of Business

John Doe

Business Trade Name

Type of Business

Business Annual Net Income
$

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 68 of 126

Schedule E Self Employment
Name of Business

John Doe

Business Trade Name

Type of Business

Business Annual Net Income
$

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 69 of 126

Schedule F Self Employment
Name of Business

John Doe

Business Trade Name

Type of Business

Business Annual Net Income
$

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 70 of 126

This screen will guide you to enter your income from all sources.
If you are unsure how to complete this screen, Please select help.

Smith, John J
Income Source

No Income

Enter Details

Wages - Wal-Mart - $25,000
Edit

Delete

Smith, Mary J
Income Source

No Income

Enter Details

Wages - Wal-Mart - $25,000
Edit

Delete

Johnson, Harry
Income Source

No Income

Enter Details

Wages - Wal-Mart - $25,000
Schedule E - ABC Corporation - less than$100,000
Edit

? Help

Delete

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 71 of 126

This screen will guide you through listing your assets and debts.
If you are unsure how to complete this screen, Please select help.

Note: If the applicant and co-applicant are spouses, please do not duplicate assets and debts.

Smith, John J
No Real Estate

Real Estate

Complete Details

4356 My Street, Dallas, TX 75248 - $250,000
Mortgage

Add

No Mortgage

Bank of America - $175,000
No Association
Association/Co-Op
Wood Park Association - $400

Add

No Personal Assets

Personal Assets

Personal Assets entered
No Extraordinary Expenses

Extraordinary Expenses

Add

Extraordinary Expenses entered
Add

No Debts

Debts

Debts entered

Leased Property

Add

No Leased Property

928 Your Street, Herndon, VA 20171
Landlord - John Smith

Smith, Robert R
Real Estate

Edit

Delete

Edit

Delete

Add

No Real Estate

4356 My Street, Dallas, TX 75248 - $250,000
Mortgage

Add

No Mortgage

Bank of America - $175,000
No Association
Association/Co-Op

Add

Wood Park Association - $400

Personal Assets

Add

No Personal Assets

Personal Assets entered
No Extraordinary Expenses
Extraordinary Expenses
Extraordinary Expenses entered

Add

No Debts

Debts

Add

Debts entered

Leased Property

Add

No Leased Property

10026 Your Street, Herndon, VA 20171
Landlord - John Smith

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 72 of 126

Real Estate
Address of disaster damaged property (dynamically generated)
Street

* Street #

Rural Route

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
* City

* State

* Zip Code

* County

* Year Purchased
(YYYY)
* Purchase Price
* Current Resale Value (Pre - Disaster)
* Property Type

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 73 of 126

Real Estate
Address of disaster damaged property (dynamically generated)
Street

Rural Route

* Number

Box

Rural Route
Address Line 2
* City

* State

* Zip Code

* County

* Year Purchased
(YYYY)
* Purchase Price
* Current Resale Value (Pre - Disaster)
* Property Type

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 74 of 126

Association/Co-Op Contact Information
Name of Organization
Phone Number
Contact Name
* Association Fee

* Frequency

Association Address
Street

* Street #

Post Office Box

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
City

State

Zip Code

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 75 of 126

Real Estate Mortgage
Address

* Name of Mortgage Holder
* Monthly Payment
* Balanced Owed
Is this a line of credit?
Yes

Maximum Credit Line
Are there any real estate taxes, insurance premiums included in your
monthly mortgage payment?
Yes

No
* Amount

* Frequency

Real Estate Taxes
Hazard Insurance
Previous

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 76 of 126

Please list other assets you own

If you are unsure how to complete this screen,

please select help.

Description

Total Amount

Cash and Bank Accounts (Include Certificates of Deposit but do
not include IRA's, Keogh's, or similar restricted retirement
accounts. Do Not include insurance proceeds.)
IRA's, Keogh's, and other similar restricted retirement accounts
Market value of stocks, bonds and other securities
Resale value of furnishings, household goods and appliances
Resale value of other assets (vehicle(s), boat, recreational vehicle, other assets)

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 77 of 126

Extraordinary Expenses
*Are you required to pay child care, child support or
alimony?
Yes (Indicate the amount per month)
No
*Do you pay tuition for schools required by medical disability, etc?
Yes (Indicate the amount per month)
No
*Do you pay unusually high and long-term medical costs?
Yes (Indicate the amount per month)
No
*Note: Include expenses that are expected to continue for 10 months
or more. DO NOT include normal living expenses.

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 78 of 126

Please provide information about your debts excluding
mortgages, rent, and extraordinary expenses.
Name of Creditor

Type of
Debt*

Payment
Frequency *
Amount *

Balance
Owed

How Secured

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 79 of 126

Rent/Lease Information
Street

* Street #

If you are unsure how to complete this screen, please select help.

Rural Route

* Street Name

* Street Type

Suffix

Unit/Suite/Number

Address Line 2
* City

* State

* Zip Code

* County

Landlord
* Name
Address
Phone Number
* Rent/Lease Amount

* Frequency

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 80 of 126

Rent/Lease Information
Street

If you are unsure how to complete this screen, please select help.

Rural Route

* Number

Box

Rural Route
Address Line 2
* City

* State

* Zip Code

* County

Landlord
* Name
Address
Phone Number
* Rent/Lease Amount

* Frequency

? Help

Exit

OMB Control No. 3245-0017 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 81 of 126

Summary of Business Financial Documents
Please review the below summary of your financial documents. If you would like to edit or delete information on
this screen, you may do so now. If you are unsure how to edit or delete information, please select help.

ABC Corporation
Profit & Loss Statement
Net Profit $250,000
Balance Sheet
Net Worth $1,250,000
Schedule of Liabilities
Liabilities Entered
Monthly Sales Figures
Sales Entered
Edit

Delete

Johnson Wax, LTD
Profit & Loss Statement

Submit Offline

Balance Sheet

Submit Offline

Schedule of Liabilities

Submit Offline
Edit

ACME Corporation
Profit & Loss Statement

Submit Offline

Balance Sheet
Net Worth $4,250,000
Schedule of Liabilities

Submit Offline
Edit

? Help

Delete

Exit

OMB Control No. 3245-0018 Exp. 12/31/2008

Business 3245-0018

09/12/2008

Page 82 of 126

Options for Submitting Financial Information
Below are the methods, which you may use to submit your financial documents. Please print this
screen for you information.
1. Online: This is the best way to submit your financial information. You should have
available to you all the financial information necessary to complete this document. If you do
not, you may want to select another option of deliver to the SBA.
2. E-mail: Include your Electronic Loan reference # 1000000001 and your full name in the
subject line of your e-mail. E-mail your documents as an attachment to: [email protected]
3. Fax: Include your Electronic Loan reference # 1000000001 and your full name on each
page of the faxed document. Send the Fax to SBA at: 817-XXX-XXXX
4. In-Person: Customer Service Representatives may be available in your area. Visit
www.sba.gov for the location of a center near you. If you cannot find a location, contact our
Customer Service Center at (800) 659-2955, or (800) 877-8339 for customers with speech or
hearing disabilities.
5. Mail: Include your Electronic Loan reference # 1000000001 and your full name on each page.
Mail the documents to SBA at:
U.S. Small Business Administration
Processing and Disbursement Center
Attn: ELA Mail Department
P.O. Box 156119
Fort Worth, TX 76155

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Financial Document Delivery Options
Select the method you wish to use to deliver your financial information to the SBA. If you are unsure how to
complete this screen, please select help.

ABC Corporation
Profit & Loss Statement
Complete Online

Submit Offline

Balance Sheet
Complete Online

Submit Offline

Schedule of Liabilities
Complete Online

Submit Offline

Monthly Sales Figures
Complete Online

Submit Offline

Johnson Wax, LTD
Profit & Loss Statement
Complete Online

Submit Offline

Balance Sheet
Complete Online

Submit Offline

Schedule of Liabilities
Complete Online

Submit Offline

ACME Corporation
Profit & Loss Statement
Complete Online

Submit Offline

Balance Sheet
Complete Online

Submit Offline

Schedule of Liabilities
Complete Online

Submit Offline

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Profit & Loss Statement (For Last 2 Years) for XYZ Corporation
Period Start MM/YYYY
Period End

MM/YYYY

Revenue:
Gross Revenue
Cost of Goods Sold
Gross Profit (Loss)

Total Expenses

Net Income

Expenses:
Depreciation
Interest
Maintenance and Repairs
Rent
Salary
Other

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Balance Sheet for XYZ Corporation
Date MM/YYYY
Current Assets
Cash
Accounts Receivable
Inventory
Prepaid Expenses
Notes Receivable
Total Current Assets

Fixed Assets
Vehicles
Depreciation
Furniture and Fixtures
Depreciation
Equipment
Depreciation
Building
Depreciation

Land

Total Fixed Assets
Total Assets

$0
$0

Current Liabilities
Accounts Payable
Tax Payable
Wages Payable
Unearned Revenue
Short Term Notes Payable
Total Current Liabilities

Long-Term Liabilities
Long Term Notes Payable
Mortgage Payable
Total Long-Term Liabilities

Total Liabilities

Net Worth

Liabilities + Net Worth

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Schedule of Liabilities for XYZ Corporation
Name of Creditor

Original
Amount

Original
Date
(MM/YYYY)

Current
Balance

Current?

Maturity
Date
(MM/YYYY)

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Payment Amt
(Per Month or Year)

How Secured

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Additional Information for XYZ Corporation
In order for SBA to calculate your full eligibility please provide monthly sales figures for the 3 years
prior to the disaster. Note: The total figures for each year should reconcile to the sales figures on your tax returns
for the corresponding year.

2005

Month

2006

2007

Current year
to date

January
February
March
April
May
June
July
August
September
October
November
December
Total

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Additional Information for Commercial Fisherman
Licenses Required (Copy of each for both Vessel and Individual)
1. Commercial Fisherman's License
2. Oyster Dredge License
3. Commercial Fishing Boat License

EXCEPTION: If a fisherman is licensed as a Commercial Bait or Bay Shrimper, he/she is exempt from
needing a Dredge and Commercial Fishing Boat License.

Proof of Boat Ownership (copy of each)
1. Bill of Sale, Title to Boat or Documentation Papers (from Coast Guard)
2. Current Registration Receipt.

Monthly Sales & Catch Figures
1. Provide Monthly Sales (in $) & Catch Figures (in lbs.) beginning 3 years prior to the disaster continuing through the
most recent month available.
2. Please note: The total figures for each year should reconcile to the sales figures on your tax returns for the
corresponding fiscal years.

2005
Month

2006

2007

To Date/Current
Year

$ Sales Catch# $ Sales Catch# $ Sales Catch# $ Sales Catch#

January
February
March
April
May
June
July
August
September
October
November
December
Total
*Note: The total sales figures for each year should reconcile to the sales figures on your tax returns for the corresponding year.

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In this section we ask you other relevant questions
To complete this section, you will need the following information
For the business and each principal/owner with 20% or greater ownership:
Account information on existing direct or guaranteed Federal and SBA loans,
if available
Details on delinquent taxes, if available
Details on bankruptcies, if available
Details on any outstanding judgments and pending lawsuits, if available

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Hazard Mitigation
PHYSICAL DAMAGE LOANS ONLY. If your application is approved, you may
be eligible for additional funds to cover the cost of mitigating measures (real
property improvements or devices to minimize or protect against future
damage from the same type of disaster event). It is not necessary for you to
submit the description and cost estimates with the application. SBA must
approve the mitigating measures before any loan increase.
By checking this box, you are interested in having SBA consider this
increase.
I am interested in Hazard Mitigation

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If you answer Yes to any of the questions, please provide the requested information.
Has the business or a listed owner ever had or guaranteed a Federal loan or a Federally
guaranteed loan?
Yes
No
* Borrower(s) Name(s)
Agency Name

Office Location

Account Number
Is the business or a listed owner delinquent on any Federal taxes, direct or guaranteed Federal
loans (SBA, FHA, VA, student, etc.), Federal contracts, Federal grants, or child support payments?
Yes
No
* Debtor's Name(s)
Agency Name

Office Location

Account Number

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* Has the business or a listed owner ever been involved in a bankruptcy or insolvency
proceeding?
Yes
No
* Debtor's Name(s)
Description

Type of bankruptcy
Discharged?
Year Discharged

Yes

No
(YYYY)

* Does the business or a listed owner have any outstanding judgments, tax liens or pending
lawsuits against them?
Yes
No
* Name(s)
Date

(MM/DD/YYYY)

Description

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* Has the business or a listed owner ever been convicted of a felony committed in connection
with a riot or civil disorder or ever engaged in the production or distribution of any product or
service, that has been determined to be obscene by a court of competent jurisdiction?
Yes

* Name(s)
Description

* Is the business or a listed owner currently suspended or debarred from
contracting with the Federal government or receiving Federal grants or
loans?
Yes

Description

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* Is the applicant or any listed owner currently, or have they ever been:
• under indictment, on parole or probation;
• charged with or arrested for any criminal offense other than a minor motor vehicle violation, including offenses which have
been dismissed, discharged, or not prosecuted; or
• convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending
probation, for any criminal offense other than a minor motor vehicle violation?

Yes

* Name

Description

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Does any owner, owner's spouse, or household member work for SBA or
serve as a member of SBA's SCORE, ACE or Advisory Council?
Yes
No

Name

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Agreement and Certification
SBA has my permission, as required by the Privacy Act, to release
information to Federal, state, local or private disaster relief services
(American Red Cross, Salvation Army, Mennonite Disaster Services, etc.).
Yes
No

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Loan Representative Information
Did anyone other than an SBA representative assist you in completing this
application, whether you paid a fee for this service or not?
Yes
No

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Loan Representative Information
* Name

Company

Contact Phone Number
Current Mailing Address
Street

Street #

Post Office Box

Street Name

Street Type

Suffix

Unit/Suite/Number

Address Line 2
City

State

Zip Code

Fee Charged

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Loan Representative Information
* Name

Company

Contact Phone Number
Current Mailing Address
Street

Post Office Box

Postal Type

Box Number

Address Line 2
City

State

Zip Code

Fee Charged

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* Are you a U.S. citizen?
Yes
No

* Are you a Lawful Permanent resident alien?
Yes
No

* Provide alien registration number:

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NOTICE OF CRIMINAL PENALTIES FOR FALSE STATEMENTS AND MATERIAL OMISSIONS: Under Title 18
U.S.C. § 1040, any person who falsifies or conceals a material fact or makes a material misrepresentation in
connection with obtaining a disaster loan from or approved by the Small Business Administration can be subject to
criminal prosecution leading to imprisonment of up to 30 years and/or a fine of up to $250,000.
Read the following language carefully. Checking the box below indicates your agreement with the
following conditions and your certification as to the truthfulness of your application.
A. I authorize my insurance company, bank, financial institution, or other creditors to release to SBA all records
and information necessary to process this application.
B. I give my permission to release information in connection with this application to Federal, state, local, or private
organizations that provide relief for disaster related purposes.
C. I will not exclude from participating in, or deny the benefits of, or otherwise subject to discrimination under, any
program or activity for which I receive Federal financial assistance from SBA, any person on grounds of age, color,
handicap, marital status, national origin, race, religion, or sex.
D. I 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 have not paid anyone connected with
the Federal government for help in getting this loan.
CERTIFICATIONS: By checking the box below, I certify as follows:
(1) I have carefully reviewed each response to every question on this application and all supporting documents
provided in connection with my application, and that all responses and documents are true and complete to the best
of my knowledge.
(2) All financial statements submitted with this application fully and accurately present the financial position of the
business and I have not omitted any disclosures in these financial statements.
(3) I acknowledge that SBA is relying on this information in determining the eligibility of the applicant for an SBA
disaster loan, and that false statements or concealing material information may subject me to the criminal penalties
discussed above and/or forfeiture of benefits.
I Agree
If your loan is approved you will be required to sign this statement at loan closing.

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Please use this space for any additional information you wish to provide.
You cannot use the Enter Key or special characters

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The following item(s) are necessary to submit your application. You may enter them below, or
exit and return later to provide the information. If you choose to return later, you will be
returned to this page when selecting "Continue An Existing Application" after logging back
into the website.
Business Primary Applicant SSN

XXX-XX-XXXX

Business Primary Applicant EIN

XX-XXXXXXX

Business Owner Social Security Number

XXX-XX-XXXX

Business Owner EIN

XX-XXXXXXX

To assist you in gathering the information, you may print your list of
missing information by clicking the Print List button .
Previous

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ABC Corporation

Ref# 1000000752

Before SBA can process your application, you must provide a completed Tax
Information Authorization (IRS Form 8821) for the applicant, each owner, principal
and affiliate.
Tax Information Authorization (IRS Form 8821)
Applicant:
Click on the name to view the IRS Form 8821. Print and return the
• ABC Corporation signed IRS Form 8821 to SBA (You must include your 10 digit
reference # and full name) by:

Owner(s):

E-m ail

• Smith, Hanna
• Smith, Mark

Mail

E-mail your documents as an attachment to: [email protected]
Mail to:

Affiliate(s):
• Z Company
• Joe's Dinner

In-Person

U.S. Small Business Administration
Processing & Disbursement Center
Attn: ELA Mail Department
P.O. Box 156119
Fort Worth, TX 76155

You can click on http://www.sba.gov for the location of a
center near you. If you cannot find a location, contact our
Customer Service Center @ (800) 659-2955, or (800) 8778339 for people w ith speech or hearing disabilities.

Also provide the following:
A current (within 1 month of the application date) pay stub for:
• Smith, Hanna
Hard copies of Federal Income Tax Returns
Applicant:
• ABC

Corporation

Tax Years 2005, 2006, and 2007

Owner(s):
• Smith, Hanna

Tax Years 2007

• Smith, Mark

Tax Years 2007

Affiliate(s):
• Z Company
• Joe's Dinner

Tax Years 2007
Tax Years 2007

ABC Corporation Financial Documents
(Financial items completed online will not appear below but will be included when you submit this
application.)
• Profit and
• Balance

Loss (dated within 90 days of application)

Sheet (dated within 90 days of application)

• Schedule

of Liabilities

• Monthly Sales Figures

Print List

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Submit Application
To finish, click Submit.

Submit

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Do you need to enter another application?
Yes
No

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Notice:
You are being redirected from a secure site.
Do you want to proceed?

Business 3245-0018

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You chose not to allow us to release information to other disaster relief
agencies or services. Other relief agencies or services rely on information
from the SBA to determine if you qualify for other assistance. You may not
receive some of the assistance for which you qualify. If you would like to
authorize the release of information, click Allow Release, otherwise click Next.
Allow Release

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You have said you do not accept our Terms of Use.
Please call our Customer Service Center at (800)
659-2955 or (800) 877-8339 for people with speech
or hearing disabilities, if you have questions about
our Terms of Use.

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We did not find any existing applications for you. If
this is incorrect, please contact our Customer
Service Center at (800) 659-2955 or (800) 8778339 for people with speech or hearing disabilities.

Business 3245-0018

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“You have said you do not acknowledge. Please call
our Customer Service Center at (800) 659-2955 or
(800) 877-8339 for people with speech or hearing
disabilities, if you have questions”

Business 3245-0018

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You have said you do not accept the Statements and
Executive Orders. Please call our Customer Service
Center at (800) 659-2955 or (800) 877-8339 for
people with speech or hearing disabilities, if you have
questions about the Statements and Executive
Orders.

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There are currently no active declarations for the
State and County combination you have selected.
Please contact Customer Service Center at (800)
659-2955 or (800) 877-8339 for people with speech
or hearing disabilities.

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You have exceeded the maximum number of
attempts. Your account is locked. Please contact
our Customer Service Center at (800) 659-2955 or
(800) 877-8339 for people with speech or hearing
disabilities.

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Please select at least one of the damage types.

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Is your business a Non Profit Organization - Please select Yes or No.

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Notice:
You are being redirected to a secure
site. Do you want to proceed?

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Warning
You are not registered yet. If you leave now,
you will have to start the registration process
over.

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Warning
You are not registered yet. If you wish to
return, please visit our homepage to register
at www.sba.gov to start the registration
process over.

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Your information is saved.
You have not completed your information. To
complete your information, log back in.

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You must agree to continue. Please call our Customer Service Center at (800)
659-2955 or (800) 877-8339 for people with speech or hearing disabilities, if you
have questions. Click CANCEL to close message to check I Agree check box.
Click OK to exit and close browser.

CANCEL

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Your application has been submitted. Your
application will not be considered complete until you
submit the required supporting documentation. Your
Reference Number is 1XXXXXXXXX. Please write
it down for future reference.

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You have changed the delivery method or device used to
receive your validation code. You must login to verify
that your selection is working properly. If you are unable
to log back in, please call our Customer Service Center
at (800) 659-2955 or (800) 877-8339 for individuals with
speech or hearing disabilities.

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Your Registration is successful and complete.

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Do you wish to delete this information?

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File Type	application/pdf
File Title	document
Author	MLMOSELE
File Modified	2008-09-12
File Created	2008-09-11