1

Augusta Small Business

Loan Program
Small Business. Big Plans.

LOAN APPLICATION
Thank you for contacting the Augusta Small Business Loan Program for a business loan. We believe
in small business and support entrepreneurial activity in our growing economy. Feel free to contact us
at any point during the process with questions at 540-245-5619.

Our loan program is facilitated through a partnership with the Staunton Creative Community Fund.
Send your completed Loan Application to Staunton Creative Community Fund at:

Staunton Creative Community Fund (SCCF)

10 Byers Street
Staunton VA 24401
eleanor@stauntonfund.org
540-213-0333

Set up a meeting with SCCF to discuss your application.

1. Bring each of the items in Required Documentation section on the last page of the Loan Application to
your meeting. SCCF will discuss your application materials, answer questions that you have, and
determine what information is still needed.

2. When SCCF has received all of your information, the Loan Review Committee will review your
application. In making its decision, the Committee will consider your:

a. Business Plan: What is your business idea? What items or services will you sell? What is
your experience in producing them? Have you managed a business? How will you compete
and market your business? What will your monthly expenses and sales revenues be for one
year?

b. Collateral: We expect you to provide collateral to secure the loan (i.e.: unfinanced vehicle,
business assets, equipment, machinery, and available personal assets). A co-signer with a
reasonable credit score and income level who could pay your loan balance if necessary may be
required. We will work closely with you to build a strong business plan.

c. Equity: In what ways will or have you provided equity to your business, either through cash or
in-kind contributions?

d. Credit History: We will review your credit history and discuss it with you.

3. Each application is reviewed based on individual circumstances. Please contact SCCF at (540) 213-
0333 or email eleanor@stauntonfund.com with any questions.
 2

Copies of SCCF’s Business Plan and Cash Flow Templates, as well as its Personal Financial Statement
form, may be found by visiting its website at: http://stauntonfund.com/programs/resources/

The Staunton Creative Community Fund is an Equal Opportunity lender, provider, and employer.

The following application is comprised of two sections, the Business Section, which requests information
specific to the business, and the Owner Section, which should be completed by each owner. An “owner” is
considered any individual obtaining at least 20% ownership in the business. Please complete and return this
application to:
Staunton Creative Community Fund
10 Byers Street
Staunton, VA 24401

BUSINESS SECTION

BUSINESS DESCRIPTION

Business Name:
Business Address:
Business Email:
Name: Phone:
Business Contact:
Address:
Is this a new business? Yes No Date started:
Organization Type: Sole Proprietorship Partnership LLC S Corp. C Corp
EIN Number:
DUNS Number:
Current number of full-time employees:
Current number of part-time employees:
Current annual sales/business revenue:

Describe the concept for your business:

Describe your products/services:

 3

Describe your experience in producing them and in managing a business:

Describe your target market (Who are your customers? Where are they located?)

Name and location (distance from you) of your competitors:

How you will attract customers from your competition:

Other information you would like us to know about your business:

If your loan is approved, how many new employees, including yourself, will you hire who will be
Full-time: ______
Part-time: ______

All start-up or significantly expanding businesses must submit a business plan and cash flow
projections with this application.
 4

LOAN REQUEST INFORMATION

Loan Amount Requested: $

Term Requested: 1 yr. 2 yrs 3 yrs 4 yrs 5 yrs 6 yrs.
How much money will you provide from your own funds? $

Describe the purpose of the loan. How will you use the loan proceeds?

Augusta County provides a reduced interest rate incentive for businesses that purchase goods and
services through other local businesses. Do you plan to purchase any of your new equipment,
supplies, or other business related activities that are financed with your loan through local vendors? If
so, please describe.

COLLATERAL TO BE PROVIDED FOR LOAN

Describe existing business assets:

Describe assets to be purchased with loan proceeds:

Other collateral available to secure the loan:

Contingency Plan: If you are not approved for this loan what is your secondary plan of action?
 5

OWNER SECTION

CONTACT INFORMATION

Name:
Social Security Number:
Address:
Email:
Telephone Number: Home:
Cellular:
Office:
Previous Address:
Spouses Name:
Spouses Social Security Number:

PERMISSION TO OBTAIN YOUR CONSUMER CREDIT REPORT

I hereby give the Staunton Creative Community Fund the right to obtain a consumer credit report regarding me
for this application and the life of the loan should my application be approved. I also release from all liability all
persons, companies, and corporations supplying such information. I indemnify the Staunton Creative
Community Fund and Augusta County against any liability, which might result from making such an
investigation.

Name: Social Security

Number:
Date of birth:
Signature: Date:

SCCF recommends loan applicants obtain, review, and submit a free copy of their credit reports, along
with a credit score, at the time of the loan application. Credit scores and free reports are available for
download at www.annualcreditreport.com.
 6

PERSONAL INFORMATION
(Please complete the following or attach a resume with your application)
Current employer: Address:
Salary: Job Title:
How long there: Duties:
Supervisor’s name: Telephone:

Last employer: Address:

Salary: Job Title:
How long there: Duties:
Supervisor’s name: Telephone:
Reason for leaving:

Previous employer: Address:

Salary: Job Title:
How long there: Duties:
Supervisor’s name: Telephone:
Reason for leaving:

Previous employer: Address:

Salary: Job Title:
How long there: Duties:
Supervisor’s name: Telephone:
Reason for leaving:
 7

INCOME AND DEMOGRAPHIC VERIFICATION

Name: SSN:
Home address:

Please check the boxes that apply to you:

Male American Indian/Alaska Native
Female Asian
Elderly (over 62 years of age) Native Hawaiian or Pacific Islander
Single Parent (at least one child under 19) American Indian/Alaska Native and White
Person with disability Asian and White
Veteran Black or African American and White
Non-US Citizen Am. Indian or Alaska Native and Black or
Hispanic/Latino African American
Black or African American Other (more than one race)
White
__-
________________________________________________________________________________________

Find the line for your household size and then check whether your income over the previous 12 months is
above or below the income amount listed on that line. You will check only one box. Total household income is
defined as income of all household members over the age of 17 received from all sources, such as wages,
salaries, interest income, investment income, social security, public assistance, or other sources.

Persons in household,
including yourself Income Level Above Below
(Circle household size first) (Then indicate if your income level is above or below the amount on that
line)

1 ..................................................... $33,050 ..........................................................

2 ..................................................... $37,800 ..........................................................
3 ..................................................... $42,500 ..........................................................
4 ..................................................... $47,200 ..........................................................
5 ..................................................... $51,000 ..........................................................
6 ..................................................... $54,800 ..........................................................
7. .................................................... $58,550 ..........................................................
8. .................................................... $62,350 ..........................................................

I certify that I have answered this question to the best of my ability. I understand that the information I have
given is subject to verification.

CERTIFICATION STATEMENT
I certify that the information above is correct to the best of my knowledge. I authorize SCCF to make inquiries
as necessary to verify the accuracy of the statements made by me and to determine my creditworthiness. I
have read and understand the fees outlines above. I agree to indemnify and hold harmless Augusta County,
SCCF, its officers, directors, employees, agents and volunteers from any and all claims, loss or other liability
arising from or related to the services that SCCF provides before, during, and after the loan review process. I
agree to pay the required sums and I agree to be bound by the loan agreement, if my application is accepted.

Notice: SCCF is dedicated to maintaining the confidentiality of all private client information including
proprietary business data, business plans, and tax ID numbers. As an organization receiving financial support
 8

from state and federal agencies, we may be required to document and share client information with public and
non-profit agencies as a condition of program funding. Such information will be treated as confidential by all
parties and shared only to the extent required for program compliance and not for further distribution.

_________________________________________________ _____________________
Owner Signature Date

Staunton Creative Community Fund is a non-profit 501c(3) corporation

 9

REQUIRED DOCUMENTATION

In addition to this application, bring the following to your meeting with SCCF.

With every application:

 Complete business plan with two-year cash flow projections
For Existing Businesses Only:
 Copy of business federal tax returns (3 years)
 Income statement and balance sheet for 3 years including year to date
 Copy of any bankruptcy discharge order during the past 7 years (if applicable)
One per owner (any individual obtaining at least 20% ownership in business):
 Personal financial statement (using form provided by SCCF)
 Copy of any bankruptcy discharge order during the past 7 years (if applicable)
 Recent copy of personal credit report and credit score
 Copy of personal tax returns (3 years)
 Copy of driver’s license or other form of ID

Please initial here to indicate your acknowledgement of reading and understanding this checklist of
required application documentation:

_____________________________ _______________________
Initials Date

If your loan is approved, additional documents will be required before closing.

Thank you for submitting your application. We look forward to working with you.