Please consider all questions or fields as required; do not enter symbols for those questions inquiring about percentage of ownership; do not enter dollar signs or commas into the fields asking for financial data, and make sure to enter whole or rounded figures. The County's COVID-19 Emergency Small Business Loan Fund (SBLF) represents four related, but separate, loan programs. Maximum loan amounts range from $10,000 to $20,000; and interest rates are from zero to two-percent, with loan terms extending up to five years. If your small business or non-profit meets the following criteria, then please consider applying to the SBLF. Your business / organization is an independently-owned, non-franchise business that has been operating for at least 12 consecutive months in Rock County, prior to the date of this funding application; has annual revenues less than $1 Million; has at least one employee, but not more than 20 employees; has experienced at least a 25% decrease in revenue/sales due to COVID-related impacts; and it can document said decrease(s); is not a membership-based or foreign-owned establishment; government, religious institution and educational provider; nor is it a Class A licensed alcohol establishment, registered tobacco business and firearms dealer or a sales; gambling, lobbying, management of companies, media, piercing, real estate and tattoo establishment; and it does not represent a business generally considered to be detrimental to Rock County’s public, health, safety and welfare. For additional information, contact us.
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Is your for-profit, non-franchise, independently-owned business located in Rock County, WI?
Has your Rock County business been in operation for at least 12 consecutive months?
Does your Rock County business have more than one location?
Does your Rock County business employ between 1-20 employees [NOTE: Enter specific details in the below Employment Table. For guidance, visit this IRS link]?
Can you demonstrate that COVID-19 caused at least a 25% decrease in revenue for your Rock County business [NOTE: Enter specific details in the below Revenue Table. Additional documentation will be required to be uploaded before this application can be submitted]?
Are there any current tax liens or legal judgments against you professionally (i.e. your Rock County business); or you personally [NOTE: For the purposes of this application, current as defined at the last five years, 2016 – 2020. If Yes, then enter these details in the below Tax Liens / Litigation Table]?
Has the applicant, or any owner, officer, subsidiary or affiliate, been involved in a lawsuit in the last 5 years?
Has the applicant, or any owner, officer, subsidiary or affiliate, ever been involved in a bankruptcy or insolvency proceeding; or are any such proceedings pending?
In the last 5 years, has the applicant, or any owner, officer, subsidiary or affiliate, been charged with a crime; ordered to pay or otherwise comply with civil penalties imposed; or been the subject of a criminal or civil investigation?
Does the applicant, or any owner, officer, subsidiary or affiliate, have any outstanding tax liens?
NOTE: If the answer is YES to any of these questions, please provide a brief explanation and then upload that information at the Documentation upload section.
Employment Type(include business owner into the count)
Full-Time
Part-Time
Temporary / Contracted
Total Employees
As of March 1, 2020
As of the Date of this Application
Can you demonstrate that COVID-19 caused at least a 25% decrease in revenue for your Rock County business [NOTE: Enter specific details in the below COVID-19 Impact Table. Additional documentation will be required to be uploaded before this application can be submitted]?
Total Sales
Total Revenue
Total Expenses
Net Income
Please complete the following COVID-19 financial resource table [NOTE: Do not include your Rock County COVID-19 Emergency Small Business Loan Fund information in this table]. When possible, use specific dates and dollar amounts; otherwise, insert estimates.
Date of Funding Application
Funding Amount Requested
Date of Funding Notification
Date of Funding Deposit
Amount of Funding Received
Use of Funding (enter payroll, rent, mortgage interest, utilities, or the name of the use)
Note: Anyone with 20% or more ownership in the business is considered to be a co-applicant.
The following information is required for program reporting and statistical monitoring purposes. Your response to these questions will not impact the status or evaluation of your application.
Briefly describe how the requested funds will be used to stabilize, sustain, strengthen or restart your business during these challenging times? In doing so, please make sure to identify what types of operational and/or structural changes your business will implement as a means to adapt and/or overcome these short-and-long term COVID-19 impacts.
Please complete the following YR 2024 Projected Financial table by entering the requested values [NOTE: If the number is $150,000 then enter 150000]
Total A/R
Total A/P
Total Payroll
Total Non-Owner Payroll
Rent / Mortgage
Utilities
Taxes
Suppliers / Vendors
Are there any other additional services that you need (please describe)?
Please upload any additional documents that demonstrate how COVID-19 caused declines in your business revenue of 25% or greater. Examples include: point-of-sales reports, quarterly payroll and/or sales tax filings, tax returns, etc.
When requested, I/we agree to track and share data on the economic impact(s) achieved as a result of this Rock County COVID-19 Emergency Small Business Loan Fund, including but not limited to: jobs retained/created; recovered, stabilized or increased sales; access to capital, including lines of credit and permanent working capital; recovered, stabilized or improved vendor and/or supply chain relationships; etc.
I (the Primary Applicant) hereby authorize the administrator of the Rock County COVID-19 Emergency Small Business Loan Fund to make all inquiries with credit bureaus and others it deems necessary – including business counselors, consultants and partnering agencies – to verify the accuracy of the information provided herein and to determine credit worthiness. I further hereby authorize a criminal background check, and understand that certain findings may disqualify my application. Further, I certify that all of the information submitted in this application is valid, accurate and complete. A photographic or facsimile copy of this authorization may be deemed to be equivalent of the original.