Name of Business (required)
Business Owner Name (required)
Business Owner Email (required)
Contact Phone Number (required)
Business Address (required)
Have you applied for any Federal Funding program? (i.e. SBA's Economic Injury Disaster Loan or the Paycheck Protection Program) (required) YesNoOther
If yes, have you been approved for funding? (required) YesNoOther
Type of Industry (required) —Please choose an option—Retail - OnlineRetail - StorefrontPersonal Care (barber shop, nail salon etc.)Professional Services (accounting, insurance etc.)Restaurant/Food IndustryOther
If Other, please list below.
Size of Business (# of employees) (required) —Please choose an option—0-56-1516-25
Date Business Established (required)
Amount of funds being requested (up to $5,000) (required)
Please give a brief description of how you plan to use the funds. (required)
Please give a brief description of how your business has been impacted by COVID-19. Example - had to close the doors, lay off employees, etc. (required)
Please list all business debt. (To Whom Owed, Original Amount and Date, Present Balance, Term of Loan, Interest Rate, Monthly Payments etc.) (required)
I grant the Tell City Revolving Loan Fund Board permission to run a credit check. (required) YesNo
I am willing to sign an affidavit, saying that I am current with all taxes. (required) YesNo
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