Small Business Emergency Assistance Program Application

English

All applications may be subject to disclosure under the Freedom of Information Act (with personal information redacted). However, attachments such as bank information and tax documents are exempted from disclosure.

PLEASE READ CAREFULLY BEFORE SUBMITTING

The information contained in this application is provided to the City of Little Rock Department of Housing and Neighborhood Programs (HNP). The applicant acknowledges and understands that HNP is relying on information provided herein in deciding to loan funds. The applicant agrees to notify HNP immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any information contained in this application or (2) in the financial condition of the applicant or (3) in the ability of any of the applicant to perform its (or their) obligation to HNP. If the applicant fails to notify HNP as required above, or if any of the information herein should be inaccurate or incomplete in any material respect, HNP may declare the indebtedness immediately due and payable.

Spanish

Todas las solicitudes pueden estar sujetas a divulgación en virtud de la Ley de Libertad de Información (conocido como FOIA, por sus siglas en inglés), (con la información personal redactada). Sin embargo, los anexos Como información bancaria y documentos fiscales están exentos de divulgación.

POR FAVOR LEA CUIDADOSAMENTE ANTES DE ENVIAR

La información contenida en esta aplicación se proporciona al Departamento de Vivienda y Programas Vecinales (conocido como HNP, por sus siglas en inglés) de la Ciudad de Little Rock para prestar fondos al negocio nombrado abajo, bajo la garantía del solicitante. El solicitante reconoce y entiende que HNP se basa en la información proporcionada en este documento al decidir prestar los fondos. El solicitante se compromete a notificar a HNP inmediatamente y por escrito de cualquier cambio en el nombre, dirección o empleo y de cualquier cambio adverso importante (1) en cualquier información contenida en esta aplicación o (2) en la condición financiera del solicitante o (3) en la capacidad del solicitante para cumplir con su obligación a HNP. Si el solicitante no notifica a HNP como se requiere anteriormente, o si alguna de la información contenida aquí esta incorrecta o incompleta en cualquier aspecto importante, HNP podrá declarar el endeudamiento inmediatamente adeudado y pagadero.

An * (asterisk) means that the field is required. If a required field is not completed your application will not be able to be submitted.

Una * (asterisco) significa que una respuesta es requerido. Si una de los respuestas requeridos no estan llenas su aplicacion no podria ser metido.

Data consent for data storage *

Yes, I give permission to store and process my data. Si, doy permiso para almacenar y procesar mis datos.
No, I don't consent to storing and processing my data. No, no doy mi consentimiento para almacenar y procesar mis datos.

Business Name *

Type of Business *

Are you a Minority or Women Owned Business? ¿Es usted una minoría o es una mujer propietaria de un negocio? *

Yes/Sí
No

SSN/TIN *

Business Address *

Business City, State, Zip Code *

Business Phone Number *

Please provide a brief description of your business (Do not exceed 500 characters) *

When did your business start operations? *

Have you been in business for at least two years? ¿Tiene al menos dos años con el negocio? *

Yes/Si
No

What was your business revenue for 2019? *

What was your business’ profit or loss for 2019? *

Did your business take a profit or loss in 2019? *

Profit/Ganancia
Loss/Pérdida

What is the legal entity of your business? *

Corporation/Corporación
LLC Compañía de Responsabilidad Limitada (conocido como LLC por sus siglas en inglés
Sole Proprietorship Empresario por cuenta propia
Other Otra

Do you own 100% of the business? *

Yes/Sí
No

Do you own more than 50% of the business? * ¿Es dueño de más del 50% del negocio? *

Yes/Si
No

Do you work in the business? *

Yes/Sí
No

Number of full time employees, including yourself before COVID-19? *

Number of part time employees, including yourself before COVID-19? *

Number of full time employees, including yourself after COVID-19? *

Number of part time employees, including yourself after COVID-19? *

Title of full time job created or retained? *

Title of part time job created or retained? *

Owner's name *

Owner's email address *

Owner's home address *

Owner's City, State, Zip Code *

Owner's home phone number *

Owner's cell phone number *

Best time to call *

Morning/Mañana
Afternoon/Mediodía

Number of persons in the household? *

Total household income? *

Loan amount request? *

Use of Funds and how company has been impaired by COVID-19 (Do not exceed 500 characters) *

Monthly rent *

Monthly mortgage payment *

Average monthly utility costs *

Monthly payroll expenses (including all related payroll expenses) *

Monthly employee benefits *

Monthly debt service payments *

Other fixed monthly expenses *

Monthly cost of goods *

SUBTOTAL *

Cash on hand *

Accounts payable amount *

Based on current business volume estimated monthly revenue *

Estimated monthly revenue *

Have you ever declared personal or business bankruptcy? *

Yes/Sí
No

If yes, was the bankruptcy discharged or dismissed more than 12 months ago?

Yes/Sí
No

Are you or your business currently subject to any lawsuits or legal proceedings? *

Yes/Sí
No

Do you have any past due tax liabilities or tax liens? *

Yes/Sí
No

Have you applied/received any other forms of assistance? *

Yes/Sí
No

If yes what other types of assistance have you received and the amount *

How much did your receive? ¿Cuánto ha recibido?

I certify that I am the owner of the above-named Small-Business and that my business meets the requirements for the Small Business Emergency Assistance as *

A for profit small business/ Una pequeña empresa con fines de lucro
A for-profit micro-enterprise business/ Una microempresa con fines de lucro

Signature of Applicant (TYPE YOUR NAME) By inputting your name below, the applicant certifies the information is true and accurate under pains and penalties of perjury. *