Form 5, SBA Disaster Loan Application Instructions

Enter the first line of an additional business address, if applicable.

Enter the second line of an additional business address, if applicable.

Enter the city for an additional business address, if applicable.

Enter the state abbreviation for an additional business address, if applicable.

Enter the zip code for an additional business address, if applicable.

Select this option if your business owns the additional business address space.

Select this option if your business leases the additional business address space.

If you answered 'Yes' to any of the questions above, provide dates and details about each occurrence.

Enter the full name of the agent you paid to support you in completing this application.

Enter the company name of the agent you paid to support you in completing this application, if applicable.

Enter the first line of the address of the agent you paid to support you in completing this application.

Enter the second line of the address of the agent you paid to support you in completing this application, if applicable.

Indicate if you paid anyone to assist you in completing this application. Provide details of the fee for services.

Enter the address line 1 of the business location that was affected by the disaster event.

Enter the address line 2 of the business location that was affected by the disaster event (optional).

Enter the city of the business location that was affected by the disaster event.

Enter the month (in two digits) when you established or acquired your business.

Enter the day (in two digits) when you established or acquired your business.

Enter the year (in four digits) when you established or acquired your business.

Provide additional details if the establishment or acquisition date of your business was within the past year. Include information about the dates and percentage of ownership of all owners. If this is a new business, state that it is a new business. Attach additional pages if needed.

If your business uses another name, enter it here. This should be the business name on your federal tax return.

If your business uses another name, enter it here. This could be a trade name or DBA (Doing Business As).

Provide your Federal Tax ID, which can be either your Employer Identification Number (EIN) or Social Security Number (SSN).

Enter the 6-digit NAICS code that best describes your business. The NAICS code is used to classify the type of business you operate.

If you are a business entity, provide your legal entity name as filed on your taxes.

Enter your business's EIN (Employer Identification Number), which is a nine-digit number.

Provide the legal entity name of your business as it appears on your tax filings.

Specify the percentage of the business that you own.

Indicate whether you are a partner or managing member for any other businesses.

Enter the city where your business is located.

Enter the state abbreviation (e.g., VA) where your business is located. Maximum length is 2 characters.

Enter the ZIP code (e.g., 12345) where your business is located. Maximum length is 5 characters.

Enter the name of your business.

Indicate whether you own more than 50% of any other businesses.

Indicate whether you are a partner or managing member of any other businesses.

Indicate whether you own more than 50% of any other businesses by selecting 'Yes'.

Indicate whether you are a partner or managing member for any other businesses by selecting 'Yes'.

Indicate whether you do not own more than 50% of any other businesses by selecting 'No'.

Select this checkbox if your business is structured as a Sole Proprietorship.

Select this checkbox if your business is structured as a Cooperative.

Select this checkbox if your business is structured as a C-Corporation.

Select this checkbox if your business is structured as an S-Corporation.

Select this checkbox if your business is structured as an Employee Stock Ownership Plan (ESOP).

Select this checkbox if your business is structured as a Housing Cooperative.

Select this checkbox if your business is structured as an Independent Contractor.

Select this checkbox if your business is structured as a Joint Venture.

Select this checkbox if your business is structured as a Limited Liability Company.

Select this checkbox if your business is structured as a Non-profit organization.

Select this checkbox if your business is structured as a Partnership.

Select this checkbox if your business is structured as a Professional Association.

Select this checkbox if your business is structured as a Qualified Joint Venture.

Select this checkbox if your business is structured as a Trust.

Select 'Yes' if you are a United States citizen. If you are not, the SBA may contact you for more information about your citizenship status.

If you are not a United States citizen, provide your registration number here.

Check this box if you do not have a registration number and are not a United States citizen.

Select 'No' if you are not a United States citizen. The SBA may contact you for more information about your citizenship status.

Select 'Yes' if you consent to using electronic signatures and electronic communications.

Select 'No' if you do not consent to using electronic signatures and electronic communications.

Enter the month (e.g., 01 for January) when you are signing this form. Maximum length is 2 characters.

Enter the day (e.g., 01) when you are signing this form. Maximum length is 2 characters.

Enter the year (e.g., 2023) when you are signing this form. Maximum length is 4 characters.

Provide your signature to complete the form.

Enter your full name and title.

Provide your email address for contact purposes.

Enter the area code of your primary phone number.

Enter the first 3 digits of your primary phone number.

Enter the last 4 digits of your primary phone number.

Enter the first 3 digits of an additional phone number, if you have one.

Enter the 4th to 6th digits of an additional phone number, if you have one.

Enter the last 4 digits of an additional phone number, if you have one.

Enter your email address for contact purposes.

Enter the area code of your primary phone number.

Enter the next 3 digits of your primary phone number.

Enter the last 4 digits of your primary phone number.

Enter the area code of an additional phone number we should use to contact you.

Enter the next 3 digits of an additional phone number we should use to contact you.

Enter the last 4 digits of an additional phone number we should use to contact you.

Provide the name of the primary point of contact for your loan application.

Provide the title or role of the primary point of contact at your business.

Provide the email address of the primary point of contact.

Check this box if your business does not have an email address.

Enter the area code of the phone number for the primary point of contact.

Enter the next 3 digits of the phone number for the primary point of contact.

Enter the last 4 digits of the phone number for the primary point of contact.

Enter the area code of an additional phone number for the primary point of contact.

Enter the next 3 digits of an additional phone number for the primary point of contact.

Enter the last 4 digits of an additional phone number for the primary point of contact.

Select this option if the structure of your business was damaged or destroyed.

Select this option if business furniture, equipment, and/or inventory were damaged or destroyed.

Select this option if business transportation vehicles (car, truck, boat, etc.) were damaged or destroyed.

Select this option if your business suffered a loss of working capital (also called Economic Injury).

Indicate if Owner 1 is a veteran. This information is optional.

Indicate if Owner 1 is a service-disabled veteran. This information is optional.

Indicate if Owner 1 is the spouse of a veteran. This information is optional.

Indicate if Owner 1 is not a veteran. This information is optional.

Indicate if Owner 1 prefers not to answer the veteran status question. This information is optional.

Indicate if Owner 1 identifies as male. This information is optional.

Indicate if Owner 1 identifies as female. This information is optional.

Indicate if Owner 1 identifies as a gender other than male or female. This information is optional.

Indicate if Owner 1 prefers not to answer the gender identity question. This information is optional.

Select this option if Owner 1 identifies as Hispanic or Latino. This field is optional.

Check this box if Owner 1 identifies as American Indian or Alaska Native. This field is optional and you can select multiple races.

Check this box if Owner 1 identifies as Asian. This field is optional and you can select multiple races.

Check this box if Owner 1 identifies as Black or African American. This field is optional and you can select multiple races.

Check this box if Owner 1 identifies as Native Hawaiian or Pacific Islander. This field is optional and you can select multiple races.

Check this box if Owner 1 identifies as White. This field is optional and you can select multiple races.

Check this box if Owner 1 prefers not to disclose their race. This field is optional.

Select this option if Owner 1 does not identify as Hispanic or Latino. This field is optional.

Select this option if Owner 1 prefers not to disclose their ethnicity. This field is optional.

Select this option if you identify as Hispanic or Latino. This field is optional.

Select this option if you do not identify as Hispanic or Latino. This field is optional.

Select this option if you prefer not to disclose your ethnicity. This field is optional.

Check this box if you identify as American Indian or Alaska Native. This field is optional and you can select multiple races.

Check this box if you identify as Asian. This field is optional and you can select multiple races.

Check this box if you identify as Black or African American. This field is optional and you can select multiple races.

Check this box if you identify as Native Hawaiian or Pacific Islander. This field is optional and you can select multiple races.

Check this box if you identify as White. This field is optional and you can select multiple races.

Check this box if you prefer not to disclose your race. This field is optional.

Enter the state abbreviation for the address of your business that was affected by the disaster event.

Enter the zip code for the address of your business that was affected by the disaster event.

Select this option if your business owns the space affected by the disaster event.

Select this option if your business leases the space affected by the disaster event.

Enter the number of employees your business had at the time of the disaster event.

Enter the first character of the disaster number that affected your business (e.g., TX-01234).

Enter the second character of the disaster number that affected your business (e.g., TX-01234).

Enter the third character of the disaster number that affected your business (e.g., TX-01234).

Enter the fourth character of the disaster number that affected your business (e.g., TX-01234).

Enter the fifth character of the disaster number that affected your business (e.g., TX-01234).

Enter the sixth character of the disaster number that affected your business (e.g., TX-01234).

Enter the seventh character of the disaster number that affected your business (e.g., TX-01234).

Select this checkbox if your business has suffered economic injury due to a military reservist being called to active duty.

Enter the name of the reservist employee if you selected Military Reservist Economic Injury.

Enter the first 3 digits of the Social Security Number of the reservist employee if you selected Military Reservist Economic Injury.

Enter the middle 2 digits of the Social Security Number of the reservist employee if you selected Military Reservist Economic Injury.

Enter the last 4 digits of the Social Security Number of the reservist employee if you selected Military Reservist Economic Injury.

Select this checkbox if the reservist employee is also the sole owner of the business.

Select this option if you have filed for bankruptcy in the past 2 years.

Select this option if you have not filed for bankruptcy in the past 2 years.

Indicate if you are currently more than 60 days late on paying any child support obligations.

Indicate if you are not currently more than 60 days late on paying any child support obligations.

Select this option if you identify as male.

Select this option if you identify as female.

Select this option if you identify as a gender other than male or female.

Select this option if you prefer not to answer the gender identification question.

Enter the name of your Hazard Insurance company if you have one. Leave blank if you do not have Hazard Insurance.

Enter the policy number of your Hazard Insurance if you have one. Leave blank if you do not have Hazard Insurance.

Enter the current amount received from your Hazard Insurance company, if any. Leave blank if you have not received any amount.

Enter the name of your Business Interruption Insurance company if you have one. Leave blank if you do not have Business Interruption Insurance.

Enter the policy number of your Business Interruption Insurance if you have one. Leave blank if you do not have Business Interruption Insurance.

Enter the current amount received from your Business Interruption Insurance company, if any. Leave blank if you have not received any amount.

Enter the name of your Flood Insurance company if you have one. Leave blank if you do not have Flood Insurance.

Enter the policy number of your Flood Insurance if you have one. Leave blank if you do not have Flood Insurance.

Enter the current amount received from your Flood Insurance company, if any. Leave blank if you have not received any amount.

Provide the name of your Windstorm Insurance company if you have one. Leave blank if you do not have Windstorm Insurance.

Enter the policy number of your Windstorm Insurance if you have one. Leave blank if you do not have Windstorm Insurance.

Enter the current amount you have received from your Windstorm Insurance company, if any. Leave blank if you have not received any amount.

Provide the name of your Fire Insurance company if you have one. Leave blank if you do not have separate Fire Insurance.

Enter the policy number of your Fire Insurance if you have one. Leave blank if you do not have separate Fire Insurance.

Enter the current amount you have received from your Fire Insurance company, if any. Leave blank if you have not received any amount.

Select this option if you have outstanding judgments, tax liens, or pending lawsuits against you.

Select this option if you do not have outstanding judgments, tax liens, or pending lawsuits against you.

Select this option if you are currently incarcerated, or on probation or parole following conviction for a serious criminal offense.

Select this option if you are not currently incarcerated, or on probation or parole following conviction for a serious criminal offense.

Indicate if, in the past year, you have been convicted of a felony committed during and in connection with a riot, civil disorder, or other declared disaster.

Indicate if, in the past year, you have not been convicted of a felony committed during and in connection with a riot, civil disorder, or other declared disaster.

Indicate if you have ever been engaged in the production or distribution of a product or service that has been determined obscene by a court of competent jurisdiction.

Indicate if you have never been engaged in the production or distribution of a product or service that has been determined obscene by a court of competent jurisdiction.

Indicate if you are currently suspended or debarred from contracting with the Federal government or receiving Federal grants or loans.

Indicate if you are not currently suspended or debarred from contracting with the Federal government or receiving Federal grants or loans.

Enter the first line of an alternative address for sending mail about your application, if you prefer.

Enter the second line of an alternative address for sending mail about your application, if applicable.

Enter the city of the alternative address for sending mail about your application.

Enter the state abbreviation (e.g., VA) of the alternative address for sending mail about your application.

Enter the ZIP code (e.g., #####) of the alternative address for sending mail about your application.

Specify the percentage of the business that you own.

Indicate if you own more than 50% of any other businesses by selecting 'Yes'.

Indicate if you are a partner or managing member for any other businesses by selecting 'Yes'.

Enter your full legal name, including first, middle, and last names.

Enter the month (in two digits) of your date of birth.

Enter the day (in two digits) of your date of birth.

Enter the year (in four digits) of your date of birth.

Enter the first 3 digits of your 9-digit Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

Enter the 4th and 5th digits of your 9-digit Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

Enter the last 4 digits of your 9-digit Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

Select 'Yes' if you are currently married. This information is used to confirm your details with the IRS.

Select 'No' if you are not currently married. This information is used to confirm your details with the IRS.

Select this option if you are not married.

Select this option if you are not a United States citizen. The SBA may contact you for more information about your citizenship status.

Enter your full legal name, including first, middle, and last names.

Enter the month of your birth date in a two-digit format (e.g., 01 for January).

Enter the day of your birth date in a two-digit format (e.g., 15).

Enter the year of your birth date in a four-digit format (e.g., 1980).

Enter the first three digits of your Social Security Number.

Enter the next two digits of your Social Security Number.

Enter the last four digits of your Social Security Number.

Select this option if you are married.

Select this option if you are a United States citizen. If not, the SBA may contact you for more information about your citizenship status.

Indicate whether you are a United States citizen. If not, provide your registration number.

Check this box if you do not have a registration number.

Enter your first and last name.

Enter your first name and last name.

Check this box if you want to receive updates about your loan via text message. Note that messaging rates may apply.

Select this option if you are a veteran.

Select this option if you are a service-disabled veteran.

Select this option if you are the spouse of a veteran.

Select this option if you are not a veteran.

Select this option if you prefer not to answer the veteran status question.