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COVID-19 Small Business Economic Support Fund

Small Business Economic Support Fund Application

*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.*