SBA Form 700 Busin Disaster Business Loan Inquiry Record

DISASTER BUSINESS LOAN INQUIRY RECORD
PLEASE NOTE: You are not required to respond to any request for information unless it displays a currently valid OMB Approval number. The estimated time to respond to this form,
including gathering the data is 15 minutes. You may send comments or questions regarding this time or other aspect of this form to: Director, Records management Division, 409 Third
Street, S.W., Washington D. C. 20416, and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202,
Washington DC 20503.
PURPOSE: Your responses to the questions on this form will help SBA’s Office of Disaster Assistance to make a preliminary determination regarding your eligibility for an SBA disaster
loan. SBA may also report the information to the Federal Emergency Management Agency (FEMA) to facilitate your receiving assistance from that agency. The information requested
includes your social security number. At this preliminary stage, providing your social security number is voluntary; however, Executive Order 9397, as amended, allows SBA to collect
the number to help distinguish you from others with the same or similar name who may have also applied for assistance from SBA and/or FEMA. SBA will protect your personal
information to the extent permitted by law, including the Privacy Act and the Freedom of Information Act, and SBA’s Privacy Act System of Records, SBA 20–Disaster Loan Case Files.
OMB No. 3245-0084
Expiration Date: xx/xx/xxxx

1. NAME OF PROSPECTIVE APPLICANT
legal name

2. E-Mail Address:

trade name

3. SSN/EIN OF PROSPECTIVE APPLICANT:

4. FEMA REGISTRATION NUMBER:

5. MAILING ADDRESS
number

street

city

county

state

zip

city

county

state

zip

6. BUSINESS LOCATION, if different
number

street

7. TELEPHONE at place of business
area code

8. TELEPHONE OF ALTERNATIVE CONTACT

number

name

area code

9. TYPE OF BUSINESS ACTIVITY

10. TYPE OF ORGANIZATION
Sole proprietorship

Partnership

Corporation

Other:

11. INQUIRER
Name
If not applicant, relationship to applicant
Mailing address, if different from applicant’s
Telephone number, if different from applicant’s

12. PAPER APPLICATION ISSUED ON:
(Date)
Type:

physical

EIDL

13. COMMENTS

14. INTERVIEWER
signature

printed name

location
SBA Form 700 Business (xx-xx) Ref. SOP 50-30

title

declaration number
Previous Editions Obsolete

date

number