Open for Business Loan Application

The Kerr-Tar Regional Council of Governments Open for Business Loan Program helps finance existing local small to medium size businesses throughout a 5-county region recover from the COVID-19 crisis. Eligible businesses should be small to medium size (1-99 employees) existing businesses who have been in business for at least 12 months, and must be located in Franklin, Granville, Person, Vance, and Warren counties. Documentation providing evidence of a loss in revenue since the start of the COVID-19 pandemic is required. Business owners may apply for a 5-10 year, interest free loan ranging from $10,000-$100,000. All loans will require a personal guarantee and some additional collateral. Funds may be used for working capital and/or equipment and require an application fee of $200. Standard loan terms of 10 years on equipment and 5 years on working capital. Flexibility in payback period will be considered if requested and approved by the COG Board. Years of business operation and proximity to downtown areas are weighted preferences for loan approval.

A. Contact Information
Please provide the following information.
Applicant Information*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
County*
Last 4 digits of Social Security Number*
Date of Birth*
Month
Day
Year
Primary Phone*
Secondary Phone
NC Driver's License Number*
Email Address*
Gender*
Co-Applicant Information (if applicable)
First Last
Co-Applicant Address
Street Address Address Line 2 City State ZIP Code
Co-Applicant Last 4 digits of Social Security Number
Co-Applicant Date of Birth
Month
Day
Year
Co-Applicant Primary Phone
Co-Applicant Secondary Phone
Co-Applicant NC Driver's License Number
Co-Applicant Email Address
Co-Applicant Gender
B. Business Information
Please provide the following information.
Business Name*
Federal Tax ID*
Business Address*
Street Address Address Line 2 City State ZIP Code
Business Type*
If other, please specify.
Briefly describe your business.*
How is your business structured?*
What percentage ownership do you have in your business?*
Should your request be approved, each owner of 20% or more must sign the Loan Agreement.
How many employees do you have?*
Number of jobs saved/retained by borrowing these funds*
Last year's gross revenues*
Are you in active bankruptcy?*
Who are your current customers? How do you earn revenue?*
Briefly describe how COVID-19 has impacted your business.*
Please be as specific as possible.
C. General Demographic Questions
The following information is required for program reporting and statistical monitoring. Your response will not affect consideration of your application.
How do you or your organization identify?*
- White
- Black
- Asian
- Native American
- Native Hawaiian/Other Pacific Islander
- Other/Multi-Racial
Ethnicity*
Veteran of the U.S. Military*
Does this qualify as a minority owned business (MBE)?*
Does this business qualify as a woman owned business (WBE)?*
Is your business located in a downtown area?*
Years of Operation*
D. Loan Request
Please provide the following information.
Requested Loan Amount*
How do you intend to secure loan?*
Collateral*
List available collateral to secure loan (e.g. vehicle, property, equipment). Click the + to add a new row.
Assets available to secure this loan (describe) Asset Value Loans on Asset
How would you utilize these funds should your business be approved for a loan?*
Examples include: 1) Payroll, 2) Rent/Lease, 3) Inventory, 4) Equipment, 5) Other. Click the + to add a new row.
Use of Funds Amount $
Based on the table above, please enter specific details.*
Describe any other sources of funding you have received for COVID-19 relief (State, Local, Federal, or non-profit funding). Other funding sources are not a disqualifying factor.
Where/how did you find out about this loan opportunity?*
Check all that apply
- Newspaper
- Online Advertisement
- Billboard
- Radio
- Social Media
- Chamber of Commerce or Economic Development Professional
- Word of Mouth
- Other
E. Conflict of Interest & Assurances
Please provide the following information.
Conflict of Interest Policy Acknowledgement: Please Initial*
In order to preclude any perceived or real conflict of interest, the applicant acknowledges that he/she has no familial, business or any financial relationship with any member of the Board of Directors or staff of the Kerr-Tar Regional Council of Governments. Further, the applicant certifies that he/she will not use any funds awarded through this loan to influence or attempt to influence an officer or employee of any federal or state agency or a member of Congress or the North Carolina General Assembly.
CARES Act Assurance: Please Initial*
All loan proceeds will be used only for business-related purposes as specified in this loan application and consistent with the Coronavirus Aid, Relief, and Economic Security Act.
Non-Discriminatory Assurance: Please Initial*
The business for which these funds will be used will not discriminate in any business practice, including employment practices and services to the public on the basis of race, color, national origin, race, color, religion, marital status, handicap, age, or national origin.
F. Required Documents
Please download and complete the Certification of Downtown Business Operation and upload below.
2019 &2020 Tax Returns*
If no tax returns, need other documentation of business revenue.
Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Year to Date Balance Sheet & Profit/Loss Statement*
Drop files here or

Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Balance Sheet & Profit/Loss Statement for the past 2 years*
Drop files here or

Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Registration with the State of North Carolina*
Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Photo ID*
Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Proof of Insurance*
Accepted file types: pdf, jpg, jpeg, gif, png, doc, xls, xlsx, docx, Max. file size: 64 MB.
Submit
The undersigned hereby authorizes the Kerr-Tar Regional Council of Governments or any of its affiliates to make all inquiries with credit bureaus and others it deems necessary–including business counselors, consultants, and partnering agencies–to verify the accuracy of the information provided herein and to determine credit worthiness. Further, the undersigned hereby certifies that the enclosed application information is valid, accurate, and complete.
Signature*
Date*
MM slash DD slash YYYY

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Assets available to secure this loan (describe)	Asset Value	Loans on Asset

Use of Funds	Amount $

Open for Business Loan Application

A. Contact Information

B. Business Information

C. General Demographic Questions

D. Loan Request

E. Conflict of Interest & Assurances

F. Required Documents

Submit