New Bern COVID-19 Small Business Name of Business*Physical address of business* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What goods or services are provided at this location?*Was this business providing goods or services at this location as of March 10, 2020?* Yes No Is this business currently providing goods or services at this location? If not, give date of reopening* Yes No Reopening Date* MM slash DD slash YYYY Names of all Beneficial Owners of the business entity and percentages of ownership* Names of all officers of the business entity and titles* Total number of business employees as of March 10, 2020 including owners, if applicable*Is this business in need of financial assistance as a result of the COVID-19 declared state of emergency?* Yes No Explain how business plans to use the funds. Attach documentation, if necessary.*Necessary Documents Checklist: To prevent delays in submission, be prepared to send the following information to Befcor after submitting this online application. Copy of Business Articles of Incorporation or Operating Agreement Copy of the applicant valid business license and zoning permit Copy of W9 for the business Copy of business lease or most recent mortgage statement. Note: If lease is not currently in writing, your landlord MUST confirm lease terms in writing. Copy of EITHER a 2019 year-end financial statement and proof of revenue showing impact from COVID-19 (March and April 2020) OR a P&L for the last twelve (12) months (May 2019 - April 2020) Certification:* I, the undersigned, hereby certify that: (1) I have reviewed the COVID-19 Small Business Emergency Loan Program eligibility criteria before applying for the requested small business loan, (2) I believe my business is eligible for this loan, (3) all information and documents provided are true and accurate to the best of my knowledge, (4) applicant gives permission to Swiss Bear and/or its assigns to process the loan application, (5) this business can receive this loan without causing a violation of North Carolina conflicts of interest laws, and (6) I have the authority to take out a loan on behalf of the applicant business.Business Name*Date of application* MM slash DD slash YYYY Signature (Primary)*Title*Email* Phone*Signature (Secondary)Title (Secondary)Email (Secondary) Phone (Secondary)