Emergency Funding Application – Bourbon County Kansas

Quick Links

Search Entire Site

Sign up here for the Code Red Emergency Warning System for Bourbon County

CDBG Emergency Funding Application

Application Parameters

Bourbon County CDBG-CV Program Parameters – Click Here to View/Print
Job Certifications for Economic Development Projects – Click Here to View/Print

Application Form

Legal Name of Business:*
Type of Business:*
Duns Number:
Primary Contact Person:*
Mobile Phone:*
Business Phone:*
Email*
Enter Email Confirm Email
Website:*
Home Address of Owner:*
Project Site Address:*
Date Business Established:*
# of Owners:*
Social Media:
NAICS Code (manufacturing)
Is your business a Hospitality based company?*
Is the business located in the same city as the mailing address above?*
Business EIN*
Business Structure (LLC, Sole Proprietorship, Inc.)*
Does the applying business have a related operating or holding company?*
Other Federal Assistance Recieved:
Please mark each program you have received funding from and provide specific information on what the funds were used for. Application will not be considered without this information.
SBA Payment Protection Program (PPP)
Amount Received:*
If no funding was received from this program, please type 0 (zero).
What were funds used for (please be specific):
SBA Economic Injury Disaster Loan (EIDL)
Amount Received:*
If no funding was received from this program, please type 0 (zero).
What were funds used for (please be specific):
SBA Express Bridge Loan
Amount Received:*
If no funding was received from this program, please type 0 (zero).
What were funds used for (please be specific):
SBA Debt Relief Program
Amount Received:*
If no funding was received from this program, please type 0 (zero).
What were funds used for (please be specific):
Other Federal Program Assistance
Name of Program:
Amount Received:
What were funds used for (please be specific):
Types of Jobs Retained
If you have retained any of the jobs listed below please tell us how many times you've held that specific position.
Officials and Managers
Professionals
Technicians
Sales
Office and Clerical
Craft Workers (Skilled)
Operatives (Semi-Skilled)
Laborers (Unskilled)
Service Workers
Voluntary Demographics
Gender*
Veteran?*
Race / Ethnicity*
Total Working Capital Need:
List any and all other funding you are currently seeking, including but not limited to Bank loans, SBA loans, Public or private loans, grant funding, etc.
- SBA
- Chamber of Commerce
- E- Community
- City
- Main Street
- MCAC
- Banker/ Financing
- Other
Jobs Retained
Full Time
Part Time
Average Wages
Full Time Wages
Part Time Wages
Will Full or Part-Time jobs be retained as a result of the funds?*
What is your annual payroll?*
Prior Year Revenues
Select Year:*
Prior Year Revenues: $*
Does the business owner have a tax liability in arrears with the Kansas Department of Revenue or the IRS?*
Bank (or other organization) name:*
Please provide a description of the services provided by your business:*
Please provide a short description of how COVID-19 is negatively impacting the business (e.g. weekly sales average drop for restaurants, occupancy rate drop for hotels, etc).*
Describe how the use of the CDBG loan fund enhances the ability of this business to survive.*
What types of working capital will the funds be used for (e.g. commercial loan payments, commercial lease payments, utilities, payroll, accounts payable, etc.)?*
Please list any other business resource partners that the business is working with if any (e.g. small business development centers, Economic Development Organization, industry or trade services).*
Certification
Authorized Signature*
I understand the requirements for the CDBG-CV program and certify under penalties of perjury, the information provided in this application and all supporting documents are correct. The grant will be required to repaid if false information has been provided. In lieu of signature, please provide your date of birth below.
MM slash DD slash YYYY