Payment Protection Program Applications
Loan Details
Loan Details
Company Information
Company Information
Contact Person
Contact Person
Owners
Owners
Application Form
Application Form
Welcome to the Access Private Capital Loan Application Center
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Paycheck Protection Program Loan Application
Average Monthly Payroll ($)
x 2.5 equals Loan Amount
Number of Employees
Purpose of Loan (choose other, if more than one)
Other explanation
Business Information
Type of Business
Business Legal Name
Business TIN (EIN, SSN)
Business Registration Date
Email
Phone Number
Secondary Phone Number
DBA or Trade Name (if applicable)
Business Address
Address Line 1
Address Line 2
City
State
Zip Code
To continue the application process, please upload the following documents as individual files:
• 2019 Business Tax Returns or Year End Financial Statements as of December 31, 2019
• 2019 Payroll Cost and YTD Payroll Cost through February 15, 2020
• Number of employees as of December 31, 2019 – W2 and 1099
• Number of employees as of February 15, 2020 – W2 and 1099
Verification Documents to Include:
• IRS Form 940 Employers Annual Federal Unemployment Tax Return (FUTA
• IRS Form 941 Employer’s QUARTERLY Federal Tax Return
• Detailed Payroll Reports for 2019 with corresponding bank statements
• W2 Summary
• 099 Summary
• Breakdown of payroll benefits (vacation, allowance for dismissal, group healthcare benefits, retirement benefits, etc.)
• Copy of 2019 1099s (if Independent Contractor)
• Copy of 2019 W2s (for wage earners)
Primary Contact Information
First Name
Last Name
Phone Number
Email
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Please upload Primary Applicant Driver's License or State Issued ID
Applicant Ownership
List all owners of Applicant with greater than 20% ownership stakes. Attach a separate sheet if necessary.
Title
First Name
Last Name
Date of Birth
SSN
Address
Email
Ownership %
Citizenship Status
Please upload Copy of US Permanent Resident card
Please upload documents signed by owners
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Decision
Decision
Comment
Thank you for your registration! Your loan request has been forwarded to Underwriter.
The password and link to the Customer Portal were sent to your email. Please contact our support team if you need any assistance.
1. 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?
2. 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 to the government?
3. Is the Business or any owner an owner of any other business or have common management with any other business? If yes, attach a listing of all Affiliates and describe the relationship as addendum A.
4. Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? If yes, provide details on a separate sheet identified as addendum B.
Applicants who are individuals and all 20% or greater owners of the business must answer the following questions. If questions (5) or (6) are answered “Yes” or question (7) is answered “No”, the loan will not be approved.
5. 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?
6. 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)?
7.
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AppGUID
OwnGuid
InsUpdateOwner
ReloadRes
FormType
AppStatus
WizardStep
AddedOwner
OwnerId
CheckEmailCount
CreationDate
DecisionUserId
ExecuteDS_Res
Ok
Reason:
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