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Million for Main St

Hudson Milk Company

Community Capital Success Story - Hudson Milk Company

Salon De Mode

Salon De Mode

Main Street 1

Main Street 1

Diego Housing

Diego Housing

Main Street 2

Main Street 2

Joy Cook

Joy Cook

Yonkers Brewery

Yonkers Brewery

Sweet Katie Kay

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Applicant/Business Information
How did you hear about us*
Have you ever had a loan with us*
- Yes
- No
Business Name*
Address*
Street Address Address Line 2 City State ZIP Code
County*
Mailing Address (if different)
Street Address Address Line 2 City State ZIP Code
County
Main Phone*
Cell Phone*
Fax*
EIN/TIN*
E-mail*
Website
Business Structure
Date Business was registered, incorporated or purchased
MWBE certification
- Business is not certified
- Business is certified by these entities
- Other
Description of the Business*
Years of Experience in this field*
Average Month Sales*
(in USD)
Highest Month Sales*
(in USD)
Lowest Month Sales*
(in USD)
Number of employees (incl. yourself)*
How many jobs do you anticipate to create as a result of this loan*
How many jobs would be lost if you did not get this loan*
Is your business seasonal*
- Yes
- No
Where does the business get its raw materials or supplies*
How do you pay for them
Business Location
Time at Current Location
Years*
Months*
Please enter a value between 0 and 12.
Do you*
- Own
- Rent
Landlord’s Name*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Landlord’s Phone*
Fax Number*
Landlord's Email

Loan Information
Loan Amount Requested*
Requested Term (repayment period)*
(in months)
Approximate monthly payment you would feel comfortable with*

Use(s) for Loan Funds Requested (please list individually)*

Use	Cost

Total
What is the minimum loan amount you can work with and what will the uses be*
Use(s) for Loan Funds (please list individually)*
Use Cost
Total

Business Financial Information
Owner Equity: Total dollar amount of equity that principal/owner(s) have invested in the business to date
(in USD)
Business Assets: (Materials, Inventory, Machinery, Accounts Receivable, Furniture, Fixtures, Vehicles)
Item Value (in USD) Own Free and Clear (Y=Yes/N=No)
Business Liabilities: (all business debts including credit cards, loans lines of credits etc)
Item Monthly Payment Amount (in USD) Owed to Balance (in USD)
Collateral: What collateral will be used to secure this loan?
Item Resale Value (in USD) Own Free and Clear (Y=Yes/N=No)
Monthly Business Financials
Reporting
- Actual
- Projected (only if startup)
Business Income (monthly):
Gross Sales*
(in USD)
Other income
(in USD)
Total
Business Expenses (monthly):
a. Cost of Goods Sold (raw materials, merchandise, inventory)*
(in USD)
b. Business rent/mortgage*
(in USD)
c. Salaries/Labor*
(in USD)
d. Utilities*
(in USD)
e. Insurance, Gas, Misc.*
(in USD)
f. Vehicle and other loan payments*
(in USD)
h. Other*
(in USD)
Total
Net
Professional References
Reference 1
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Contact Phone*
Work Phone
Email
Relationship*
Reference 2
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Contact Phone*
Work Phone
Email
Relationship*

Principal/Owner Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Home Phone*
Work Phone
Email*
Social Security #*
Driver’s License #*
Date of Birth*
Names Credit can be under*
Time at Current Residence
Years
Months
Do you
- Own
- Rent
Landlord’s Name*
Landlord’s Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Landlord’s Phone*
Fax Number
Email
Previous Address (if less than a year)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Do you have a bank account*
- Yes
- No
Bank Account Type*
- Personal
- Business
- Both
Percentage of business ownership*

Principal/Owner Financial Information
Monthly Personal Financials * (please provide your information only, not household):

Personal Income (monthly) :
a. Take home from business*
(in USD)
b. Employment income
(in USD)
c. Other income
(in USD)
Total
(in USD)
Personal Expenses(monthly) :
a. Education and childcare*
(in USD)
b. Food and clothing*
(in USD)
c. Child support/alimony*
(in USD)
d. Home rent/mortgage*
(in USD)
e. Utilities*
(in USD)
f. Insurance, Gas, Misc.*
(in USD)
g. Credit Cards Payments*
(in USD)
h. Vehicle and Other Loan payments*
(in USD)
i. Other
(in USD)
Total
(in USD)
Employment Information
Are you Employed?*
- Yes
- No
Explaination regarding your unemployment
Employer’s Name*
Contact Person*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number*
Fax Number
Income/month (approx.)*
Time at current employer*
Credit Information
Have you ever filed for bankruptcy*
- Yes
- No
Are you in arrears in child support payments*
- Yes
- No
Are you currently late on any mortgage and/or vehicle payments?*
- Yes
- No
Have you recently applied for a business loan to a bank?*
- Yes
- No
What was the outcome?*
Socio-Economic Information
Years of education
Marital Status
TANF recipient?
- Yes
- No
- Don’t Know
Number in household (including self)
Annual Household Income (AGI from most recent Federal Tax Return)
(in USD)
Race
Ethnic Group
Veteran Status
Are you disabled
- Yes
- No
Are there any additional principal/owners?
- Yes
- No
Will there be a co-borrower
- Yes
- No
PLEASE READ AND SIGN BELOW
By clicking on submit, I attest that all of the information on this application is true. I authorize Community Capital New York to investigate and verify the above information, and contact any references regarding this application. I also authorize Community Capital New York to perform a credit check, which may include obtaining consumer and/or commercial credit reports and to exchange information about credit experience with other creditors from time to time, as authorized by law. The release of all information by Community Capital New York, in any manner is hereby authorized whether such information is of record or not and I hereby release all persons, agencies, firms, companies etc ., from any damages resulting from such information. I understand that Community Capital New York will retain this application whether the loan is approved or denied and that I can appeal Community Capital New York’s decision if the loan is denied.

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Hawthorne, NY 10532
914.747.8020 / 914.747.2049
info@communitycapitalny.org

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