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					                              BUSINESS INFORMATION
Name of Borrower (Business Legal Name):                   Primary Business Contact:

Street Address:                                           City/State/Zip:

County:                                                   Website Address:

Street Address of New Project:                            City/State/Zip:

County:                                                   E-mail address:

Telephone #:                                              NAICS Code:

1) OWNERSHIP STRUCTURE: Proprietorship, partners, officers, directors, holders of outstanding stock. 10
percent or more of business ownership must be accounted for:
Name:                                        Title:                                      % of Ownership




List all affiliates and subsidiaries of the business:
Have there ever been judgments or injunctions against the business or owners?         Yes      No
If Yes, describe:
Is there pending litigation involving the business?      Yes        No If yes, attach summary and disposition.
Has the business or the owners of the business ever filed bankruptcy?       Yes         No If yes, describe:
2) BUSINESS STRUCTURE: Indicate type of business and provide verification:
               Corporation: Articles of Incorporation, By-Laws, Certificate of Incorporation
               Partnership: Partnership Agreement
               LLC: Articles of Organization, Operating Agreement, Member Control Agreement, Certificate of
               Organization
               Proprietorship or operates under a name other than the businesses legal name : Assumed Name
               Certificate, Affidavit of Publication
               Other:
3) OFFICERS:
President:                                                Vice President:
Secretary:                                                Treasurer:
Other:                                                    Other:
4) KEY EMPLOYEES:
Name:             Title:                                    Responsibilities:                         Years with
                                                                                                      company:



5) CURRENT EMPLOYMENT INFORMATION: Current Number of Full Time Equivalent (FTE) Employees
in Minnesota:        Current Number of Full Time Equivalent (FTE) Employees on site:
*Full Time Equivalent is based on a total annual hours of 2080
6) JOB CREATION FORM: Required with completed application. A payroll report must also be submitted.

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7) FINANCIAL INFORMATION:
Primary Bank of Account:                                    Contact Person:
Phone #:                                                    E-mail:
8) RESUMES & PERSONAL FINANCIAL STATEMENTS: Resumes as well as current (past 90 days), dated
and signed personal financial statements on all 10 percent or more of business ownership should be provided.
9) PROJECTIONS: Provide 2 years proforma balance sheets, income statements and cash flows. Define the
assumptions used to derive the projections.
10) COLLATERAL: Provide a list of all collateral offered, new and existing, its value, and security position by
funding source. Personal guarantees will be required from persons with 10 percent or more of business
ownership.
11) PROJECT COSTS: Provide cost estimates which must include the total project and be equal to the uses of
funds. Some of the cost may include machinery and equipment – vendor quotes, Real Estate – appraisal,
Construction – contractor cost estimate. Other costs should be included as well.
12) PROJECT TIMEFRAME:
                     Task:                           Estimated Completion Date:
                     Commitment of all funds
                     Start of construction
                     Purchase Equipment

13) SOURCE AND USE STATEMENT:
                                  MIF       Bank(s)      Equity       Local         Other        Total
                                                                    Government
                                                                                   (     )
     Property Acquisition
     Site Improvement
     New Construction

     Renovation of an
     Existing Building
     Purchase of Machinery
     & Equipment
     Contingency Fee
     Sanitary Sewer / Water
     Other:
         Total Project Cost
     Term (years)
     Interest Rate
     Lien Position
     Collateral
     Guarantee
     (Personal/Corporate)

      PERSONAL GUARANTEES ARE REQUIRED AS A CONDITION OF THE MIF LOAN.


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   14) ENVIRONMENTAL:
       A) Are there any environmental risks associated with the site, building, or the business itself?
       B) Will the project result in the loss or diminution of wetlands?    Yes        No     If yes, describe the
          measures which will be taken to mitigate all functional values of the wetlands that will be lost or
          diminished:
       C) Will the proposed project be located in a flood plain?      Yes       No If yes, is flood insurance
          required?     Yes         No
       D) Have state environmental review requirements been met, if applicable?         Yes        No


The data you supply in this application to the Minnesota Department of Employment and Economic Development will
be used to assess your company’s qualifications for a business loan. We will not be able to process the application
without this information. If an award is provided for the project, the information contained in the application will
become a matter of public record with the exception of those items protected under the Minnesota Government Data
Practices Act found in Minnesota Statutes 1997, Chapter 13.

I have read the above statement and I agree to supply the information requested to the Minnesota Department of
Employment and Economic Development, Division of Business and Community Development with full knowledge of
the information provided herein. I certify the information contained herein is true and accurate.



                                                         ________________________________
Signature of Company Official                            Position


________________________________
Date




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