2. First Name*
3. Last Name*
5. Business Name*
6. Phone Number
8. Physical Address*
10. Mailing Address if different than above
11. Email Address
13. Do you own/lease/rent the building you are requesting funds for?*

    1. 1. Own
    2. 2. Rent
    3. 3. Lease
15. *If you do not own the building, a letter from the owner approving requested improvements is required.
17. Amount requesting (maximum $10,000)*
19. Description of facade improvements planned with loan funds:*
21. Bank you will be working with:*
22. Lender Contact Name*
24. A letter of credit approval from the bank will be required upon Urban Renewal Approval. By signing this document, you attest that, to the best of your knowledge, the information is true and accurate. Your signature also commits you to using the loan funds for the expressed purpose you have described above and that you will work in earnest to pay off the loan in the time frame your lender has set forth.
26. Applicant Signature*
27. Date*
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field