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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General Information

Business Mailing Address
Business Physical Address (if different than above)

Business Summary

Is your for-profit, non-franchise, independently-owned business located in Rock County, WI?

This field is required.

Has your Rock County business been in operation for at least 12 consecutive months?

This field is required.

Does your Rock County business have more than one location?

This field is required.

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]?

This field is required.

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]?

This field is required.

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]?

This field is required.
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 Table

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

COVID-19 Impact Table

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]?

Category
Jan-Dec 2025
Jan-Dec 2024
Jan-Dec 2023
Jan-Dec 2022
Jan-Dec 2020

Total Sales

Total Revenue

Total Expenses

Net Income

Financial Resources

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.

SBA EIDL
SBA Express Bridge Loan Pilot
SBA PPP

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)

USDA Rural Development Relief
WEDC 20/20
Other

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)

Primary Applicant Contact

Are there any co-applicants?

Note: Anyone with 20% or more ownership in the business is considered to be a co-applicant.

This field is required.
Primary Applicant Demographic Information

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.

This field is required.
This field is required.
This field is required.
This field is required.

Loan Request

Use of Funds

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]

Category
Q2 2025
Q3 2025
Q4 2025
Q1 2026

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)?

Documentation

Copies of business year-end and quarterly Balance Sheets and Profit & Loss Statements for 2019-2024
[NOTE: Upload each year separately in the below File Upload sections.]
File upload is required Choose File
File size must be less than 4000 kb Choose File
File size must be less than 4000 kb Choose File
File size must be less than 4000 kb Choose File
File size must be less than 4000 kb Choose File
Copy of business W-9 Taxpayer Identification Number and Certificate pdf only
File upload is required Choose File
Copy of business WI Department of Revenue’s Business Tax Registration Certificate pdf only
File upload is required Choose File
Copy of business WI Department of Financial Institution’s Registration Certificate pdf only
File upload is required Choose File
Copy of business Certificate of Insurance document(s)pdf only
File upload is required Choose File
Copies of quarterly business bank account statements (for the periods of January 1, 2020 – December 31, 2020; January 1, 2021 – December 31, 2021; January 1, 2022 – December 31, 2022; January 1, 2023 – December 31, 2023; and Jan. 1, 2024 – December 31, 2024) pdf only
File upload is required Choose File
Copy of applicant’s WI Driver’s License (front and back) pdf only
File upload is required Choose File
Additional Documentation of COVID-19 Impactspdf only

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.

File size must be less than 4000 kb Choose File

Final

Agree to Share Economic Impact

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.

This field is required.
Authorization & Certification

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.

This field is required.