Government
HOME
Wyoming County, West Virginia
 Wyoming County
West Virginia
   Wyoming County Economic Development Authority

Printable Forms

Loan Application

Loan Requirements

Wyoming County Day

 

Wyoming County Economic Development Authority
Loan Application

Business Information    
       
Business Name Years In Business
Business Address
Business Phone #: Email:
Form of Business: Employer ID#:
Current # of Employees Full Time Part Time
# of Employees Expect in One Year Full Time Part Time
       
Owners Name: SSN# Percent of Ownership
       
Other Business Names:  
       
Demographic Information    
The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in the program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish the information, we are required to note the race/national origin of the individual applicants on the basis of visual observation or surname.
       
Percent of business owned by: Male: Female
Ethnicity: Hispanic/Latino    Not Hispanic/Latino
Ethnic Background (Please Check One)    
White Black/African American Asian American Indian
Alaskan Native Native Hawaiian Other Pacific Islander Other
       
This is an Equal Opportunity Program. Discrimination is prohibited by Federal Law. Complaints of
Discrimination may be filed with the Secretary of Agriculture, Washington DC, 20250
       
Narrative Description of Request
       
Collateral List    
Collateral Description (Serial Number, Deed ect.) Approximate Value
       
Funding Information      
Sources of Funding      
Source 1 Amount
Source 2 Amount
Source 3 Amount
Source 4 Amount
    Total Project Cost
       
Uses of Funds   Amount  
Land  
Building  
Construction  
Leasehold Improvements  
Machinery and Equipment  
Inventory    
Working Capital    
Other    
  Total  
       
The information provided in this application for the Revolving Loan Fund is true and complete to the best of my/our knowledge. I/We understand that any false statements will be considered as cause for possible disqualification for my/our loan. You are hereby authorized to conduct an investigation on my/our personal history and/or credit and financial records employing investigation or credit agencies or bureaus of your choice, subject to the provisions of the Fair Credit Reporting Act.
       
Signature Date
       
Signature Date
       

 
 
  ©2006 All Rights Reserved Wyoming County, West Virginia