CARES Act RLF Application

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06/20/2021
Company Information
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MM/DD/YYYY
 
LLC
 
LLP
 
S Corporation
 
C Corporation
 
Non-Profit Organization
 
Sole Proprietorship
 
Check here if your project address is different from the mailing address above.
Contact Information
To help ensure your email address is correct, please enter it a second time.
Business OwnershipPlease include owner(s), officer(s), & shareholder(s) who own 20% or more shares of the company. *

Owner #1:


* Personal financial statements and tax returns are required for those with 20% or greater ownership interest. The Mississippi River Regional Planning Commission and/or its agents reserves the right to obtain credit bureaus on any business or individual in connection with this application.

Bank Information
Revolving Loan Fund Request

Repayment Terms will be determined prior to closing, Please contact the MRRPC for current terms.

Anticipated Sources of All Project Funds

Sources include the loan you are requesting from the Mississippi River Regional Planning Commission plus any other financing that will go into the project including but not limited to bank financing and owner cash.

Note: Applicants are required to have 10% equity in the project (building, cash, etc.)


$0
Anticipated Uses of All Project Funds

$0
Jobs Retained
Newly Created Job Positions
0
Required Exhibits

The following exhibits must be completed where applicable and included as part of your application. After you submit this first page, you will receive an email with the list of documents needed and a link to attach those exhibits at a later time. You will also be taken to a form to begin uploading any exhibits you may have already prepared.

The Mississippi River Regional Planning Commission reserves the right to request additional information above and beyond this list.

  • Business Tax Return for last fiscal year.
  • Balance sheet and profit and loss statement for an interim period not more than ninety days preceding the date of application.
  • Schedule of business debt.
  • Business description and financing proposal. This should include a brief company history and a description of the financing proposal; a discussion of the impact of COVID-19 on your business and your response; a discussion of your industry, sales, and markets; discussion of competition; description of owners and key employees; and other matters relevant to your application.
  • Personal financial statements and most recent personal tax return of principal owners (owners with 20% or more ownership).
Questions

Has the company, any officer, subsidiary, or affiliate of your company been involved in any bankruptcy or insolvency proceedings in the last 36 months?

 
Yes
 
No
You will be asked to provide the details as a separate exhibit.

Has the company, any officer, subsidiary, or affiliate of your company been involved in any lawsuits in the last 36 months?

 
Yes
 
No
You will be asked to provide the details as a separate exhibit.

Does the company, any officer, subsidiary, or affiliate have any outstanding tax liens?

 
Yes
 
No

Does the company, owner(s), or member of Management Team have a controlling interest in other businesses?

 
Yes
 
No
Total number of all businesses for all owners. E.g., If 2 owners have interests in 1 company each, the total is 2.
You will be asked to provide their names and relationship with your company along with a current balance sheet and income statement for each as a separate exhibit.

Does your company buy from, sell to, or use the services of any concern in which owner(s), shareholder(s) or member(s) of the management team have a significant financial interest?

 
Yes
 
No
You will be asked to provide the details as a separate exhibit.

Are any of the individuals listed under "Management" on parole or probation?

 
Yes
 
No
You will be asked to provide the details as a separate exhibit.

Have any of the individuals listed under "Management" been convicted of a crime?

 
Yes
 
No
You will be asked to provide the details as a separate exhibit.
Digital Acceptance & Signature

BY SIGNING BELOW, THE APPLICANT

  • certifies that to the best of its knowledge and belief, the information being submitted to the Mississippi River Regional Planning Commission, and its agent is true and correct;
  • certifies that the applicant is in compliance with all laws, regulations, ordinances, and orders of public authorities applicable to it;
  • certifies that the applicant is not in default under the terms and conditions of any grant or loan agreement, leases, or financing arrangements with its other creditors;
  • certifies that the Mississippi River Regional Planning Commission and its agent is authorized to obtain a credit check on any principal or business associated with this application for the purposes of determining credit worthiness;
  • agrees to reimburse the Mississippi River Regional Planning Commission and its agent for any reasonable expenses made in connection with this loan request, including, but not limited to, title work, legal fees, appraisals, recording/filing fees, etc.;
  • certifies that the applicant has disclosed and will continue to disclose any occurrence or event that could have an adverse material impact on the project. Adverse material impact includes but is not limited to lawsuits, criminal or civil actions, bankruptcy proceedings, regulatory interventions or inadequate capital to complete the projects; and
  • understands that unless it qualifies as a trade secret, all information submitted to the Mississippi River Regional Planning Commission is subject to Wisconsin’s Open Records Law.

In the event credit is extended, the applicant agrees to complete a direct payment authorization form allowing loan payments to be electronically debited via automatic clearing house (ACH).


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By checking this box I am digitally signing, agreeing to the statements above.

 
Check here if a second person will be signing this application.

Your social security # and all information on this form is encrypted and stored securely.
 
By checking this box I am digitally signing, agreeing to the statements above.
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