*If persons with disabilities and/or non-English speaking persons require assistance with the application, please notify the City via the following contact information.
Email: sbesf@nlr.ar.gov
Phone: (501) 214-1880
All applications may be subject to disclosure under the Freedom of Information Act (with personal information redacted).
An * (asterisk) means that the field is required. If a required field is not completed your application will not able to be submitted.
Data Consent for data storage *
Yes, I give permission to store and process my data.
No, I do not consent to storing and processing my data.
Business Name *
Business License Number *
Type of Business *
Business Address *
Business City, State, Zip Code *
Business Phone Number *
Please provide a brief description of your business - type of goods or services provided (Do not exceed 500 characters) *
When did your business start operations? *
What is the legal entity of your business? *
Corporation
LLC
Sole Proprietorship
Other
If other, please provide explanation below
Do you own 100% of the business? *
Yes
No
If no, indicate percentage of business that you own. *
Do you work in the business? *
Yes
No
Check any of the following that apply to your business: *
Minority-owned business
Woman-owned business
Disabled Veteran-owned business
None of the above
Number of full time employees, including yourself before COVID-19? *
Number of part time employees, including yourself before COVID-19? *
Number of full time employees, including yourself after COVID-19? *
Number of part time employees, including yourself after COVID-19? *
Owner's first name *
Owner's last name *
Owner's email address *
Owner's home address *
Owner's City, State, Zip Code *
Owner's cell phone number *
Owner's home phone number *
Best time to call *
Morning
Afternoon
Loan amount request? *
How company has been impacted by COVID-19 (Do not exceed 500 characters) *
Has ownership of business ever declared personal or business bankruptcy? *
Yes
No
If yes, was the bankruptcy discharged or dismissed more than 12 months ago?
Yes
No
Are you, any owner or your business currently subject to any lawsuits or legal proceedings? *
Yes
No
Do you have any past due tax liabilities or tax liens? *
Yes
No
Have you applied for or received any other form of assistance? *
Yes
No
If yes, what other types of assistance have you applied for or received and the amount? *
I believe that my business meets the requirements for the Small Business Economic Support Fund Assistance as a *
for-profit small business
for-profit microenterprise business
I have read and understand the Guidelines and the Terms and Conditions of the COVID-19 Small Business Economic Support Fund. *
Yes
No
I certify that I am the owner of the above-named small business and have the authority to execute this loan application. *
Yes
No
Signature of Applicant (TYPE YOUR NAME) By inputting your name below, the applicant certifies the information is true and accurate under pains and penalties of perjury.*