Tri County Council for Western Maryland

Business Project Summary

Name of Business:*

Is this business new or existing?*

New

Existing

If existing, what is the structure?

Sole Proprietorship

Limited Liability

C Corporation

Partnership

S Corporation

Non-Profit

Primary Contact Name:*

Primary Contact Email*

Business Address:*

Date Business Established:*

Phone:*

Is business registered in Maryland?*

Yes

Product or Service:*

Is business in good standing in Maryland?*

Yes

Industry Sector:*

Is business in good standing with County?*

Yes

Total Project Cost:*

Federal Tax ID#:*

Requested Loan Amount:*

Is this business 51% or more (check all that apply):*

Minority Owned

Woman Owned

Veteran Owned

MBE#

Is there collateral available?*

Yes

MBE#:

Describe Collateral:

Management

Proprietor, partners, officers, directors, and all shareholders of outstanding stock - 100% of ownership must be shown.

Name:*

Title:*

Home Address:*

Email:*

% Owned:*

Credit Score (if known):

% Owned:*

Credit Score (if known):

Phone:*

Type of Company Financial Statements:*

CPA Prepared

In-house

Tax Returns

Has the firm, its affiliates or any owner ever filed for bankruptcy?*

Yes

Has the firm, affiliate or any owner defaulted a loan?*

Yes

Has any owner been convicted of a crime (other than minor vehicle)?*

Yes

Have you been declined for a loan for this project by a lender?*

Yes

Are any individual or business taxes unpaid?*

Yes

Are there any judgements, lawsuits or major disputes involving the firm, affiliates, or any owner?*

Yes

If you answered YES for any of the above, please provide a brief explaination:

Project Description

Please briefly describe the proposed project. Include:

General allocation of project costs (land, building purchase, leasehold improvements, inventory, marketing, working capital, etc.)
Estimated completion date
Reason for the project (e.g. relocation, expansion, new business start-up, equipment purchase, etc.)
Indicate if this project will ADD or RETAIN jobs and, if yes, how many?

Minimum owner equity injection of 10% for start-up businesses is required.

Project Description:*

By signing this form, I/We represent and warrant that the information provided is true and correct. I/We further authorize TCCWMD to obtain credit information and make inquiries as necessary to verify the accuracy of the statements made and to determine creditworthiness. I/We further give TCCWMD the right to contact other lenders identified in this form. I/We waive all claims against TCCWMD and its consultants.

Signature:*

Date:*

Signature:

Date:

By submitting this form you are not applying to the loan fund. This form is a pre-qualification counseling tool and for discussion purposes only.

Please enter "inquiry" into the field below:*

What They’re Saying:

Spectrum Designs, LLC

“My dream of owning an interior design business would not have been possible without the help and guidance of Tri-County Council. My experience was extremely positive and for that, I am eternally grateful.

I would recommend TCC to anyone interested in pursuing a business purchase.”

Heather Lancaster

Owner

Loan Inquiry Form

Business Project Summary

Management

Project Description

What They’re Saying:

Spectrum Designs, LLC