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Disaster Relief Loan Application

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Page 1

Business Information












If not started yet, what is your estimated start date?





Personal Information
Please provide the information below as the primary owner of the business. For non-profit organizations, the Executive Director, Treasurer, and/or Board Chairperson should complete this information and list their Business Ownership as 0%.
















Other Shareholders, Members, Partners Owning 20% of More of Business
As shareholders, members, or partners owning more than 20% of the business, the individuals you list below will receive email invitations to provide their own personal information.






Personal Assets











Owned Real Estate







Personal Liabilities










Annual Personal Income





Page 2

Loan Request


Amount may not exceed $25,000.














Financial Document Upload
Thank you for considering Carolina Small Business Development Fund for your small business loan. To assist us in processing your request in an efficient manner, we ask that you please submit a complete application package to include the documents listed below. Please be aware that the loan underwriter may request additional items after receiving your loan application package.





Demographic Information (Optional)
The following information is requested by the Federal Government for certain types of loans, in order to monitor the lender's compliance with equal credit opportunity. You are not required to furnish this information, but you are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under the Federal regulations this Lender is required to note race/ethnicity on the basis of visual observation or surname. If you do not wish to furnish the following information, select the 'Decline to State' option.







Equal Credit Opportunity Act
The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. 

The Federal agency that administers Carolina Small Business Development Fund's compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Room 500, 633 Indiana Avenue N.W., Washington, DC 20580. If your application for business credit is denied, you have the right to a written statement of specific reasons for the denial. To obtain the statement, please contact Carolina Small Business Development Fund, Attention: Small Business Lending, 3128 Highwoods Blvd, Suite 170, Raleigh, NC 27604 within sixty (60) days from the date of notification of the credit denial. Carolina Small Business Development Fund will send the Applicant a written statement of the reason(s) for the denial within thirty (30) days of receiving the request for the statement.
Referral Information