Preliminary Project Information - County Loan Request
Intake Loan Form

Your Information

Name:

Phone Number:

Email Address:

Company Name:

Sponsoring Organization/Municipality (if any):

Company Name:

Borrowing Entity:

Principally owned by:

Company Address:

(Proposed) Project Address:

Brief Description of the Company:

Project Name:

Date:

The Company/Borrowing Entity proposes to ….

Projected Jobs created:

Total Project Costs: $

County Funding Request: $

Senior Lender Name:

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