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Meeker County Economic Development Authority Page 3 of 4 <br /> <br />Meeker County Economic Development Authority (MCEDA) <br /> <br />COVID-19 Business Assistance Loan Application <br /> <br /> <br />Applicant Information <br />DBA - Legal Name of the Business:___________________________________________________________________ <br />❑ Sole Proprietorship ❑ Partnership ❑ Corporation ❑ LLC <br />Length of Time <br />in Business Years Months Fed <br />Tax Id# <br />MN State <br />License <br />Mailing Address City ZIP <br />Location Address City ZIP <br />Business Phone ( ) Business FAX ( ) <br />E-Mail Address Web Address <br />Contact Name Title <br />Amount of Funding <br />Requested <br /> <br />$________________________ <br /> <br /> <br />Principal #1 <br />Name DOB SS# <br />Address City ZIP <br />Percentage of Ownership __________% <br /> <br /> <br />Principal #2 <br />Name DOB SS# <br />Address City ZIP <br />Percentage of Ownership __________% <br /> <br /> <br />Primary Lender <br />Name Phone Ref# <br />Address FAX <br />Contact Title <br /> <br />Applicant certifies that all information provided, including legal status, is true, current, and complete. <br />Applicant authorizes MCEDA to utilize credit bureau/reporting agencies for verifying the accuracy of any information <br />provided. <br />Applicant authorizes the primary lending institution to provide MCEDA with a recent credit report if one has been prepared. <br /> <br />By signing below, I/We represent that the information presented on this application is complete and accurate and that all loan <br />proceeds will be used for business working capital related purposes. <br /> <br /> <br /> <br />Principal #1______________________________________ Principal #2______________________________________ <br /> <br />Date ____________________________________________ Date ___________________________________________