JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Paycheck Protection Loan Intake Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Fill out the below questions to see if you are eligible for the PPP Program.
Business Legal Name
*
Your answer
Do you have employees? Contractors do not count.
*
Yes
No
What was your business net income for 2019 from Line 31 of your Schedule C on your tax return?
Your answer
What type of entity is your business?
*
Choose
Sole Proprietor
Partnership
C-Corporation
S-Corporation
Single member LLC
Independent Contractor
Eligible self-employed individual
501(c)(3) nonprofit
501(c)(19) veterans organization
Tribal Business (Sec. 31(b)(2)(C) of SBA
Other
Business Address
*
Your answer
Business EIN
*
Your answer
Phone Number
*
Your answer
Do you have an SBA Lender you want us to work with? Please provide contact info or website link.
*
Your answer
If you paid payroll, What payroll system are you on? Please provide access to the system.
Your answer
Purpose of the loan
*
Payroll
Rent / mortgage interest
Utilities
Required
List all owners of applicant, SSN/EIN, Ownership% , Address
*
Your answer
Is the Business or any owner presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?
*
Choose
Yes
No
Has the Business, any of its owners, or any business owned or controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and caused a loss tothe government?
*
Choose
Yes
No
Is the Business or any owner an owner of any other business or have common management with any other business? If yes, please list all Affiliates and describe the relationship
*
Your answer
Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? If yes,provide details
*
Your answer
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, on probation or parole?
*
Choose
Yes
No
Within the last 7 years, for any felony or misdemeanor for a crime against a minor, have you: 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgment)?Initial here to confirm your
*
Choose
Yes
No
Citizenship
*
US Citizen
Lawful Permanent Resident Status
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ecomcpa.com.
Report Abuse
Forms
