Form SBA 1919, SBA 7(a) Borrower Info Instructions

Check this box if the applicant plans to use a 401(k) Plan (including a Rollover for Business Start Up (ROBS) plan) as equity in the business.

Check this box if the applicant does not plan to use a 401(k) Plan (including ROBS) as equity in the business.

Check this box if the applicant will hire a management company to manage the business's day-to-day operations (if yes, provide a copy of the management agreement).

Check this box if the applicant will not hire a management company to manage the business's day-to-day operations.

Check this box if the Applicant does have one or more Affiliates as defined by 13 CFR 121.301 (if checked, attach a listing of all Affiliates).

Check this box if the Applicant does not have any Affiliates as defined by 13 CFR 121.301.

Enter the gender code of the applicant. Refer to the provided list of gender codes to find the appropriate code.

Enter the race code(s) of the applicant. You can enter more than one code if applicable. Refer to the provided list of race codes to find the appropriate codes.

Enter the ethnicity code of the applicant. Refer to the provided list of ethnicity codes to find the appropriate code.

Check this box if the applicant is organized as a cooperative business.

Check this box if the applicant is an ESOP (Employee Stock Ownership Plan).

Check this box if the applicant is a 401(k) plan (including plans used as a Rollover for Business Start Up/ROBS).

Check this box if the applicant is a trust.

Check this box if the applicant is a different type of entity not listed above and provide the specific type elsewhere on the form.

Check this box if none of the listed applicant types apply.

Check this box if the Applicant or its Affiliates has ever applied for or obtained a direct or guaranteed loan from the SBA or another federal agency (or served as a guarantor on such a loan).

Check this box if the Applicant and its Affiliates have never applied for or obtained such a federal/SBA loan and have not been a guarantor on one.

Check this box if any of the referenced federal/SBA financing is currently past due or delinquent. Fill only if 'Has the Applicant and/or its Affiliates ever obtained or applied for a federal/SBA loan? — Yes' Fill only if Question 3 is 'Yes'.

Check this box if none of the referenced federal/SBA financing is currently delinquent. Fill only if 'Has the Applicant and/or its Affiliates ever obtained or applied for a federal/SBA loan? — Yes' Fill only if Question 3 is 'Yes'.

Check this box if any of the referenced federal/SBA financing previously defaulted and resulted in a loss to the Federal Government. Fill only if 'Has the Applicant and/or its Affiliates ever obtained or applied for a federal/SBA loan? — Yes' Fill only if Question 3 is 'Yes'.

Check this box if none of the referenced federal/SBA financing has defaulted and caused a loss to the Federal Government. Fill only if 'Has the Applicant and/or its Affiliates ever obtained or applied for a federal/SBA loan? — Yes' Fill only if Question 3 is 'Yes'.

Check this box if the Applicant or any of its Affiliates has ever filed for bankruptcy protection.

Check this box if neither the Applicant nor any of its Affiliates has ever filed for bankruptcy protection.

Enter the first principal country of export.

Enter the name of the second principal country where your business exports its products or services.

Enter the name of the third principal country where your business exports its products or services.

Check this box if any employee, owner, partner, attorney, agent, owner of the stock, officer, director, creditor, or debtor of the Applicant is a former SBA employee who has been separated from SBA for less than one year prior to the request for financial assistance. If 'Yes,' provide details on a separate sheet.

Check this box if no employee, owner, partner, attorney, agent, owner of the stock, officer, director, creditor, or debtor of the Applicant is a former SBA employee who has been separated from SBA for less than one year prior to the request for financial assistance.

Check this box if any sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such individual, is a member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government. If 'Yes,' provide details on a separate sheet.

Check this box if no sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such individual, is a member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government.

Check this box if any sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such individual, is a Federal Government employee or Member of the Military having a grade of at least GS-13 or higher (or military equivalent). If 'Yes,' provide details on a separate sheet.

Check this box if no sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such individual, is a Federal Government employee or Member of the Military having a grade of at least GS-13 or higher (or military equivalent).

Check this box if any sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such an individual, is a member or employee of a Small Business Advisory Council or a SCORE volunteer. If 'Yes,' provide details on a separate sheet.

Check this box if no sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest in the Applicant, or a household member of such an individual, is a member or employee of a Small Business Advisory Council or a SCORE volunteer.

Enter the legal name of the applicant business.

Check this box when the Applicant Business Legal Name entered is the Operating Company (OC).

Check this box when the Applicant Business Legal Name entered is the Eligible Passive Company (EPC).

Enter the applicant's full legal business name as officially registered (e.g., the name on formation or tax documents).

Enter the operating company's full legal business name if different from the applicant, as it appears on official records.

Enter the 'doing business as' or trade name used by the business, if applicable; leave blank if none.

Check this box if you are a U.S. citizen.

Check this box if you have Lawful Permanent Resident status.

Check this box if you are not a U.S. citizen or Lawful Permanent Resident.

Enter your USCIS registration number.

Enter your country of citizenship.

Check this box if there are one or more co-applicants on this loan application (if checked, complete a separate Section I for each co-applicant).

Check this box if there are no co-applicants on this loan application.

Check this box if any sole proprietor, partner, officer, director, or stockholder with a 10 percent or more interest in the applicant is an SBA employee or a household member of an SBA employee. If 'Yes,' provide details on a separate sheet.

Check this box if no sole proprietor, partner, officer, director, or stockholder with a 10 percent or more interest in the applicant is an SBA employee or a household member of an SBA employee.

Check this box if you are currently subject to an indictment, criminal information, arraignment, or other formal criminal charges in any jurisdiction. Note: If 'YES,' the loan request is not eligible for SBA assistance.

Check this box if you are not currently subject to an indictment, criminal information, arraignment, or other formal criminal charges in any jurisdiction.

Check this box if you have been arrested for any criminal offense in the last 6 months.

Check this box if you have not been arrested for any criminal offense in the last 6 months.

Check this box if you have ever been convicted, pleaded guilty, pleaded nolo contendere, been placed on pretrial diversion, or been placed on any form of parole or probation (including probation before judgment) for any criminal offense other than a minor vehicle violation.

Check this box if you have never been convicted, pleaded guilty, pleaded nolo contendere, placed on pretrial diversion, nor placed on any form of parole or probation for any criminal offense other than a minor vehicle violation.

Check this box if you answered 'Yes' to Question 31 and any of the financing is currently considered delinquent. Provide the Lender with a written explanation if you answer 'Yes' to either 31(a) or 31(b).

Check this box if you answered 'Yes' to Question 31 and none of the financing is currently considered delinquent.

Check this box if you are presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. If 'Yes,' provide details on a separate sheet.

Check this box if you are neither presently suspended, debarred, proposed for debarment, declared ineligible, nor voluntarily excluded from participation in this transaction by any federal department or agency.

Check this box if the entity and/or its affiliates have never filed for bankruptcy protection.

Check this box if the entity or any of its owners is currently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. Provide details on a separate sheet if 'Yes'.

Check this box if the entity or any of its owners is not currently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

Check this box if the entity has any affiliates. Attach a listing of all affiliates if 'Yes'.

Check this box if the entity does not have any affiliates.

Check this box if the entity and/or its affiliates have ever filed for bankruptcy protection. Provide details on a separate sheet if 'Yes'.

Enter the legal name of the entity owner.

Enter the tax ID of the entity owner.

Enter the phone number of the entity owner.

Enter the address of the entity owner.

Enter the primary contact name for the entity owner.

Enter the email address of the entity owner.

Check this box if the entity owner is completing Section 3 as a 401(k) plan.

Check this box if the entity owner is completing Section 3 as an ESOP.

Check this box if the entity owner is completing Section 3 as other than a 401(k) plan or an ESOP. Please explain in a separate attachment.

Check this box if any of the applicant's products or services are exported (directly or indirectly), there is a plan to begin exporting as a result of this loan, or this is an Export Working Capital Program (EWCP) loan.

Check this box if none of the applicant's products or services are exported, there is no plan to begin exporting as a result of this loan, and this is not an EWCP loan.

Enter the estimated total export sales amount that this loan will support. Fill only if 'Question 9 (Export / EWCP) - Yes' Fill only if Question 9 is 'Yes'.

List the principal countries to which the Applicant exports (enter at least one country; separate multiple countries with commas). Fill only if 'Question 9 (Export / EWCP) - Yes' Fill only if Question 9 is 'Yes'.

Check this box if the applicant has paid or committed to pay a fee to the lender or a third party to assist with the loan application or has paid/committed to pay a referral agent or broker fee.

Check this box if the applicant has not paid and has not committed to pay any fee to the lender, a third party assisting with the loan application, or a referral agent/broker.

Enter the full legal name of the fifth owner, partner, officer, or shareholder associated with the applicant.

Provide the job title or position held by the fifth owner in the business (for example, President, Partner, CEO).

Enter the percentage of ownership in the business held by the fifth owner.

Enter the Taxpayer Identification Number for the fifth owner (SSN or EIN) as used for tax reporting.

Provide the primary street address for the fifth owner, including number and street name.

Provide any additional address details for the fifth owner, such as suite or apartment number and the city, state and ZIP code.

Check this box if the fifth listed owner is an Employee Stock Ownership Plan (ESOP).

Check this box if the fifth listed owner is associated with or covered by a 401(k) plan.

Check this box if the fifth listed owner is a cooperative.

Enter the full legal name of the owner or entity (e.g., last name, first name, middle initial or business entity name) exactly as it appears on legal documents.

Enter the owner's title or role within the business (for example: President, CEO, Partner, Member, Officer).

Enter the percentage of ownership that this owner holds in the applicant business.

Provide the owner's taxpayer identification number — either Social Security Number (SSN) or Employer Identification Number (EIN) — as it appears on tax or legal records.

Enter the owner's primary street address or mailing address (street number and name, suite or apartment if applicable).

Enter the city, state (or province) and ZIP/postal code corresponding to the street address entered on the previous line.

Check this box if the listed owner holds ownership through an Employee Stock Ownership Plan (ESOP) or the ownership interest is attributable to an ESOP.

Check this box if the listed owner's ownership interest is held through a 401(k) plan (including rollover or plan-held company stock).

Check this box if the listed owner is a member/shareholder of a cooperative (co-op) or their ownership is held in a cooperative structure.

Enter the full legal name of the fourth owner listed (individual or business entity).

Enter the fourth owner's title or position in the business (for example, President, Partner, CEO).

Enter the percentage of the business owned by the fourth owner.

Provide the fourth owner's taxpayer identification number (SSN or EIN) used for tax reporting.

Enter the fourth owner's primary street address (street number and name).

Enter the city, state and ZIP code for the fourth owner's address and any apartment or suite information if applicable.

Check this box if the fourth owner is an Employee Stock Ownership Plan (ESOP) participant or the ownership is held by an ESOP.

Check this box if the fourth owner is associated with or funded by a 401(k) plan (including rollover or other 401(k) ownership arrangements).

Check this box if the fourth owner is a member of a cooperative (COOP) or the ownership is held by a cooperative.

Check this box if the Applicant Business operates under a franchise, license, distributor, membership, dealer, jobber or any other similar agreement (and attach copies of the agreement(s) and relevant documents).

Check this box if the Applicant Business does not operate under any franchise, license, distributor, membership, dealer, jobber or other similar agreement.

Check this box if you answered 'Yes' to Question 31 and any loan for a business purpose ever defaulted and caused a loss to the government, including a compromise, resolution, or settlement of a loan's principal balance for less than the full amount due. Provide the Lender with a written explanation if you answer 'Yes' to either 31(a) or 31(b).

Enter the full legal name of the individual owner.

Enter the Social Security or tax ID number of the individual owner.

Enter the date of birth of the individual owner in the format MM/DD/YYYY.

Enter the place of birth (city, state, and country) of the individual owner.

Enter the home address of the individual owner.

Enter the home phone number of the individual owner.

Enter the ownership percentage of the individual owner.

Enter the legal name of the Applicant.

Enter the legal name of the first owner.

Enter the title of the first owner.

Enter the ownership percentage of the first owner.

Enter the TIN (SSN or EIN) of the first owner.

Check this box if the entity and/or its affiliates are currently involved in any pending legal action. If 'Yes,' provide details on a separate sheet.

Check this box if the entity and/or its affiliates are not currently involved in any pending legal action.

Check this box if you answered 'Yes' to Question 26 and any loan made for business purposes ever defaulted and caused a loss to the Government, including a compromise, resolution, or settlement of a loan's principal balance for less than the full amount due. Provide the lender with a written explanation if you answer 'Yes' to either 26(a) or 26(b).

Check this box if you answered 'Yes' to Question 26 and no loan made for business purposes ever defaulted and caused a loss to the Government, including a compromise, resolution, or settlement of a loan's principal balance for less than the full amount due.

Check this box if you answered 'Yes' to Question 26 and any of the financing is presently considered delinquent. Provide the lender with a written explanation if you answer 'Yes' to either 26(a) or 26(b).

Check this box if you answered 'Yes' to Question 26 and none of the financing is presently considered delinquent.

Check this box if you or any business you own or control have ever obtained a direct or guaranteed loan from SBA or any other federal agency, or have been a guarantor on such a loan. If 'Yes,' provide details on a separate sheet.

Check this box if you or any business you own or control have never obtained a direct or guaranteed loan from SBA or any other federal agency, nor have been a guarantor on such a loan.

Check this box if you answered 'Yes' to Question 31 and no loan for a business purpose ever defaulted and caused a loss to the government, including any compromise, resolution, or settlement of a loan's principal balance for less than the full amount due.

Enter the total amount of loan funds the business is requesting.

Provide the current total number of employees employed by the business, including owners.

Enter the number of new jobs expected to be created as a result of this loan, including any positions filled by owners.

Provide the number of jobs that will be retained because of this loan that otherwise would have been lost, including owners.

Check this box if you are a 50% or more owner of the Applicant and are more than 60 days delinquent on any child support obligation. If 'Yes,' provide details on a separate sheet.

Check this box if you are a 50% or more owner of the Applicant and are not more than 60 days delinquent on any child support obligation.

Check this box if you have any ownership in other businesses that would be defined as an Affiliate of the Applicant. If 'Yes,' attach a listing of all businesses, your title, and ownership percentage in each business.

Check this box if you do not have any ownership in other businesses that would be defined as an Affiliate of the Applicant.

Check this box if you, or any business you controlled, have ever filed for bankruptcy protection. If 'Yes,' provide details.

Check this box if you, or any business you controlled, have never filed for bankruptcy protection.

Check this box if you, or any business you control, are presently involved in any legal action (including divorce). If 'Yes,' provide details.

Check this box if you, or any business you control, are not presently involved in any legal action (including divorce).

Enter the first line of the first owner's address.

Enter the second line of the first owner's address, if applicable.

Check this box if the first owner is an Employee Stock Ownership Plan (ESOP).

Check this box if the first owner is a 401(k) plan.

Check this box if the first owner is a cooperative.

Enter the legal name of the second owner.

Enter the title of the second owner within the business.

Enter the ownership percentage of the second owner.

Enter the Taxpayer Identification Number (TIN) of the second owner, which can be either a Social Security Number (SSN) or Employer Identification Number (EIN).

Enter the first line of the second owner's address.

Enter the second line of the second owner's address, if applicable.

Check this box if the second owner is an Employee Stock Ownership Plan (ESOP).

Check this box if the second owner is a 401(k) plan.

Check this box if the second owner is a cooperative.

Enter the legal name of the third owner.

Enter the title of the third owner.

Enter the ownership percentage of the third owner.

Enter the TIN (SSN or EIN) of the third owner.

Enter the first line of the third owner's address.

Enter the second line of the third owner's address.

Check this box if the third owner is an ESOP.

Check this box if the third owner is a 401(k) plan.

Check this box if the third owner is a cooperative.

Enter the legal name of the fourth owner.

Enter the title of the fourth owner.

Enter the ownership percentage of the fourth owner.

Enter the TIN (SSN or EIN) of the fourth owner.

Enter the first line of the address for the fourth owner of the applicant business.

Enter the second line of the address for the fourth owner of the applicant business.

Check this box if the fourth owner is an Employee Stock Ownership Plan (ESOP).

Check this box if the fourth owner is a 401(k) plan.

Check this box if the fourth owner is a cooperative.

Check this box if the Applicant and/or its Affiliates are currently involved in any pending legal action.

Check this box if the Applicant and/or its Affiliates are not currently involved in any pending legal action.

Check this box if the entity has ever obtained a direct or guaranteed loan from SBA or any other Federal agency, or been a guarantor on such a loan. If 'Yes,' provide details on a separate sheet.

Check this box if the entity has never obtained a direct or guaranteed loan from SBA or any other Federal agency, or been a guarantor on such a loan.

Check this box if an application for the requested loan has ever been submitted to the SBA, a lender, or a Certified Development Company in connection with any SBA program.

Check this box if an application for the requested loan has never been submitted to the SBA, a lender, or a Certified Development Company in connection with any SBA program.

Enter the business's primary street address including suite or unit (if any), city, state and ZIP code.

Enter the business Tax Identification Number (for example, Employer Identification Number/EIN) as assigned by the IRS.

Enter the main business phone number where the company can be reached, including area code and extension if applicable.

If different from the primary address, enter the project or secondary business address including street, city, state and ZIP code. Fill only if 'Primary Business Address' Fill only if Primary Business Address is different.

Enter the full name of the primary contact person for this application (first and last name, and optionally title).

Enter the primary contact's business email address for correspondence about this application.

Enter the loan amount to be allocated to the first listed purpose.

Provide a brief description of the intended use of funds for this allocation (for example: Purchase Real Estate, Construction, Equipment, Inventory, Debt Refinancing, Working Capital).

Enter the loan amount to be allocated to the second listed purpose.

Provide a brief description of the intended use of funds for this allocation.

Enter the loan amount to be allocated to the third listed purpose.

Provide a brief description of the intended use of funds for this allocation.

Enter the loan amount to be allocated to the fourth listed purpose.

Provide a brief description of the intended use of funds for this allocation.

Enter the loan amount to be allocated to the fifth listed purpose.

Provide a brief description of the intended use of funds for this allocation.

Enter the loan amount to be allocated to the sixth listed purpose.

Provide a brief description of the intended use of funds for this allocation.

Check this box if any of the Applicant's revenues are derived from gambling, loan packaging, the sale of adult or sexually explicit products or services, or from depiction, displays or live performances of a prurient sexual nature.

Check this box if none of the Applicant's revenues are derived from gambling, loan packaging, the sale of adult or sexually explicit products or services, or from depiction, displays or live performances of a prurient sexual nature.

Enter the full legal name of the owner listed in this row (individual's first and last name or business entity name).

Enter the owner's job title or position within the business (for example: President, CEO, Partner, Manager).

Enter the percentage of ownership held by this owner in the business (you may include decimals and optionally the % sign).

Enter the owner's Taxpayer Identification Number (SSN or EIN) as provided for tax purposes, including hyphens if applicable.

Enter the owner's primary business or mailing street address (street number and name, and suite or unit if applicable).

Enter the city, state and ZIP code for the address entered above (for example: Anytown, NY 12345).

Check this box if the second owner (row 2) is part of an Employee Stock Ownership Plan (ESOP).

Check this box if the second owner (row 2) participates in a 401(k) retirement plan.

Check this box if the applicant or the second owner (row 2) is organized as or belongs to a cooperative.

Enter your digital signature here by pressing Enter.

Select or type the date of signature in the format MM/DD/YYYY.

Type your name and title here.

Enter your digital signature to confirm your response to question 19.

Enter your digital signature to confirm your response to question 20.

Enter the digital signature of the Authorized Representative of the Applicant.

Enter the date of signature in the format MM/DD/YYYY.

Enter the name of the Authorized Representative of the Applicant.

Enter the title of the Authorized Representative of the Applicant.

Enter the digital signature of the Authorized Representative of the Entity by pressing Enter.

Enter the date of signature in the format MM/DD/YYYY.

Type the name and title of the Authorized Representative of the Entity.

Enter your digital signature to confirm your response to question 17.

Enter your digital signature to confirm your response to question 18.

Check this box if the applicant is currently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

Check this box if the applicant is not suspended, debarred, proposed for debarment, declared ineligible, and is not voluntarily excluded from participation in this transaction by any federal department or agency.

Enter the full legal name of the third owner as it appears on official documents.

Enter the owner's job title or position within the business (for example, President, Partner, Manager).

Enter the percentage of the business owned by this individual.

Provide the owner's Taxpayer Identification Number (SSN or EIN) used for tax reporting.

Enter the owner's primary street or mailing address (street number and name, suite or unit if applicable).

Enter the owner's city, state (or region), and postal code for the address provided.

Check this box if the third listed owner is part of an Employee Stock Ownership Plan (ESOP).

Check this box if the third listed owner participates in or is covered by a 401(k) retirement plan.

Check this box if the third listed owner is a member of or associated with a cooperative (COOP).

Enter the veteran status code of the applicant.