Loan Application

For Minority-Owned Businesses in Miami

Please allow yourself at least an hour to fill out the form accurately and in its entirety. You will NOT be able to save your progress.

Additional Documentation

Please upload the following documents in the application below. If any of the documents are not currently available, please email them to info@miamibaysidefoundation.org.

Business Plan including corporate history and comprehensive marketing plan.
Resume of all principals.
Three (3) years Profit and Loss Projections, monthly for one (1) year, and annually for the next two (2) years. Footnote assumptions.
Detailed Use of Funds, including a breakdown of any line items over $5,000.
Business Financial Statements for the last three (3) fiscal years and year-to-date.
Corporate Tax Returns (federal income tax) for the last three (3) years.
Personal Income Tax Return filed for the last three (3) years.

Six (6) months of supporting bank statements.
Copy of Lease or Letter of Intent to Lease.
Copy of Business Documents: Partnership Agreements, Articles of Incorporation, By-Laws, Certificate of Good Standing, etc.
Copy of Local Business Tax Receipt.
Proof of General Liability Insurance.
Documentation of all Outstanding Debt Including Equipment Leases.

Business Loan Application
Business Information
Business Name*
Business DBA
Business Address as stated on Occupational License*
Street Address Address Line 2 City State ZIP Code
Does the business lease or own the property from where it operates?*
- Lease
- Own
Years at Present Location*
Type of Business*
Date Established*
Employer Identification Number (EIN)*
NAISC Code*

If you do not know your NAISC Code, go to https://www.naics.com/search/.
DUNS Number*

If you do not have a DUNS number, visit https://www.dnb.com/duns-number/get-a-duns.html to apply for one.
Present Number of Employees*
Proposed Number of Employees After Loan*

Within Two Years from Loan Amount
Website
Business Structure*
- Sole Proprietorship
- Partnership
- Corporation
Contact Person*
First Last
Person filling this out
Primary Number*
Email*
Number of stockholders, partners, and owners with ownership greater than 20%*
Please enter a number from 0 to 5.
First Owner
Name*
First Middle Last
Title*
Phone*
Email*
Number of Years*
Please enter a number from 0 to 100.
Percentage Owned*
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this owner a veteran?*
- Yes
- No
Does this owner identify as any of the following minorities?*
- Select All
- African American
- Hispanic American
- Asian American
- Native American
- Woman
- None of the Above
Second Owner
Name*
First Middle Last
Title*
Phone*
Email*
Number of Years*
Please enter a number from 0 to 100.
Percentage Owned*
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this owner a veteran?*
- Yes
- No
Does this owner identify as any of the following minorities?*
- Select All
- African American
- Hispanic American
- Asian American
- Native American
- Woman
- None of the Above
Third Owner
Name*
First Middle Last
Title*
Phone*
Email*
Number of Years*
Please enter a number from 0 to 100.
Percentage Owned*
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this owner a veteran?*
- Yes
- No
Does this owner identify as any of the following minorities?*
- Select All
- African American
- Hispanic American
- Asian American
- Native American
- Woman
- None of the Above
Fourth Owner
Name*
First Middle Last
Title*
Phone*
Email*
Number of Years*
Please enter a number from 0 to 100.
Percentage Owned*
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this owner a veteran?*
- Yes
- No
Does this owner identify as any of the following minorities?*
- Select All
- African American
- Hispanic American
- Asian American
- Native American
- Woman
- None of the Above
Fifth Owner
Name*
First Middle Last
Title*
Phone*
Email*
Number of Years*
Percentage Owned*
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this owner a veteran?*
- Yes
- No
Does this owner identify as any of the following minorities?*
- Select All
- African American
- Hispanic American
- Asian American
- Native American
- Woman
- None of the Above
Financial Information
Business Bank Account*
Account Number*

Business Debts and Credit Relationships - Include Mortgages Payable, Contracts. Notes, Business Debts, Credit Cards, etc.*

Agency's Name	Original Date	Original Loan Amount	Present Balance	Repayment Terms	Status

Loan Request
Specific Loan Purpose
Put 0 or N/A if not applicable
Working Capital*
Please enter a number from 0 to 150000.
Explain*
Purchase of Inventory*
Please enter a number from 0 to 150000.
Explain*
Purchase of Equipment*
Please enter a number from 0 to 150000.
Explain*
Expansion*
Please enter a number from 0 to 150000.
Explain*
Other*
Please enter a number from 0 to 150000.
Explain*
Total Loan Amount*
Maximum: $150,000.00
Collateral Available
Put 0 if not applicable
All Assets (accounts receivable, inventory, machinery and equipment)*
Specific Equipment (Please attach equipment list)*
Real Estate*
Personal Assets (As described in Personal Financial Statement)*
Other*
Please Specify*
Total Collateral*
Miscellaneous Information
Are tax liabilities current?*
- Yes
- No
Explain*
Is the business an endorser, guarantor, or co-maker for any obligation not listed in the financial statements?*
- Yes
- No
What is the contingent liability?*
Has the business or principal owner ever declared bankruptcy?*
- Yes
- No
Provide details on the bankruptcy*
Is the business a defendant in any lawsuit?*
- Yes
- No
Are any of the business assets encumbered by liens or attachments of any type (i.e. UCC filing)?*
- Yes
- No

What	By whom	Amount $

Certification
The undersigned certifies that to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying statements and documents is true, complete, and correct. The undersigned agrees to notify the Miami Bayside Foundation, Inc. immediately of any material changes in this information. The undersigned authorizes Miami Bayside Foundation, Inc. to contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dun & Bradstreet reports or information from any credit reporting agency.

Notice to applicants: The purpose of the Miami Bayside Foundation, Inc. is to create and administer a loan fund for minority businesses in Miami. The Lender reserves the right to recall the loan if these requirements are not met.
Name*
First Last
Date*
MM slash DD slash YYYY
Personal Financial Statement
This form is to be filled out by each Applicant with ownership of 20% and above.
First Owner
Section 1 - Personal Information
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Date of Birth*
Place of Birth*
Country
Driver's License Number*
Marital Status*
- Married
- Seperated
- Unmarried
- Divorced
Spouse: Name*
First Middle Last
Spouse: Social Security Number*
Spouse: Phone*
Spouse: Date of Birth*
Spouse: Place of Birth*
Country
Spouse: Driver's License Number*
Present Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Do you rent or own?*
- Own
- Rent
How many years have you lived at this location?*
Former Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Did you rent or own?*
- Own
- Rent
How many years have you lived at this location?*
Name of nearest relative not living with you*
First Last
Address of nearest relative not living with you*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number of nearest relative not living with you*
Relationship of nearest relative not living with you*
Section 2 - Employment Information
Name of Employer*
Type of Business*
Job Title*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone Number*
Years on This Job*
Years Employed in this Line of Work*
If employed for less than two years or if employed in more than one position, fill below.
Name of Employer*
Type of Business*
Job Title*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone Number*
Years on This Job*
Years Employed in this Line of Work*
Spouse: Name of Employer*
Spouse: Type of Business*
Come Back to this
Section 3 - Monthly Income
Salary
Spouse: Salary
Total Salary
Net Investment Income
Spouse: Net Investment Income
Total Net Investment Income
Net Real Estate Income
Spouse: Net Real Estate Income
Total Net Real Estate Income
Other Income
Describe
Spouse: Other Income
Describe
Total Other Income
Total Monthly Income
Section 4 - Monthly Contingent Liabilities
As Endorsers or Co-maker
Spouse: As Endorsers or Co-maker
Total As Endorsers or Co-maker
Legal Claims and Judgements
Spouse: Legal Claims and Judgements
Total Legal Claims and Judgements
Provisions for Federal Income Tax
Spouse: Provisions for Federal Income Tax
Total Provisions for Federal Income Tax
Other Special Debt
Describe
Spouse: Other Special Debt
Spouse: Describe
Total Monthly Contingent Liabilities
Section 5 - Assets
Cash on Hand and in Checking Account
Savings Account
IRA and Other Retirement Accounts
Accounts and Notes Receivables
Stocks and Bonds
Describe in Section 8
Life Insurance-Cash Surrender Value
Complete in Section 12
Real Estate
Complete in Section 13
Automobile - Present Value
Other Personal Property
Describe in Section 9
Other Assets
Describe in Section 9
Total Assets
Section 6 - Liabilities
Notes Payable to Banks and Others (Include Credit Cards)
Describe in Section 7
Installment Accounts (Auto-Total Outstanding)
Installment Accounts (Monthly Payments)
Loan on Life Insurance
Mortgage on Real Estate
Describe in Section 13
Unpaid Taxes
Describe in Section 10
Other Liabilities
Describe in Section 11
Total Liabilities
Section 7 - Notes Payable To Banks And Others

Name and Address of Note Holder	Original Balance	Current Balance	Payment Amount	Frequency (monthly, etc.)	How Secured Type of Collateral

Section 8 – Stocks And Bonds

Number of Shares	Name of Securities	Cost	Market Value Quotation/Exchange	Date of Quotation	Total Value

Section 9 – Other Personal Property And Other Assets
Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, detail delinquency.
Section 10 – Unpaid Taxes
Describe in detail as to type, to whom payable, when due, amount, and to what property, if any, a tax lien is attached.
Section 11 – Other Liabilities
Describe in detail.
Section 12 – Life Insurance Held
Give face amount and cash surrender value of policies - name of insurance company and beneficiaries.
Section 13 – Real Estate Owned

List each parcel separately.

Type of Property	Address	Date Purchased	Original Cost	Present Market Value	Name and Address of Mortgage Holder	Mortgage Balance	Amount of Monthly Payment

Section 14 – Declarations
Are there any outstanding judgments against you?
- Yes
- No
Spouse: Are there any outstanding judgments against you?
- Yes
- No
Have you ever declared bankruptcy?
- Yes
- No
Spouse: Have you ever declared bankruptcy?
- Yes
- No
Have you ever had property foreclosed upon or given title or deed in lieu thereof?
- Yes
- No
Spouse: Have you ever had property foreclosed upon or given title or deed in lieu thereof?
- Yes
- No
Are you party to a lawsuit?
- Yes
- No
Spouse: Are you party to a lawsuit?
- Yes
- No
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment (this would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured home loans, any mortgage, financial obligation, bond, or loan guarantee)?
- Yes
- No
Spouse: Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment (this would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured home loans, any mortgage, financial obligation, bond, or loan guarantee)?
- Yes
- No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
- Yes
- No
Spouse: Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
- Yes
- No
Section 15 - Acknowledgement And Agreement

I/We authorize Miami Bayside Foundation, Inc. to verify the accuracy of statements made and to determine my creditworthiness. I/We herein give authorization to the credit-reporting agency of your choice to deliver a credit report about my person to the interested party. I understand that I hereby waive any privileges I may have regarding the requested information to release it to the interested party. The requested information will be used in reference to my employment, banking, credit and residence as applicable and to give this information to Miami Bayside Foundation, Inc. I/We understand that the information from Equifax, TRW, and Merchants Credit Bureau. Its officers, employees, agents or suppliers shall not be liable to the agency, consumer for any claim, injury or damages upon furnishing such credit information. The credit Reporting Agency acts only as a service agent on the client’s behalf to obtain a credit report of the consumer. A copy of this form may be used in lieu of the original. I/We certify the above and the statements contained in the attachments are true and accurate as of the stated date. These information and statements are made for the purpose of obtaining a loan and I/We acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liabilities and/or criminal penalties, including, but not limited to, fine, imprisonment or both under the provisions of Title 18, United States Code. Section 1001. et seq and liability for monetary damages to Miami Bayside Foundation, Inc., its agents, successors and assigns, and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made in this application.
Name*
First Last
Date*
MM slash DD slash YYYY
Spouse: Name*
First Last
Spouse: Date*
MM slash DD slash YYYY
Statement of Personal History
This form to be filled out by each Applicant
First Name Middle Name Last Name
U.S. Citizen
- Yes
- No
Please give the number of one of the following documents
Birth Certificate Passport Certificate of Naturalization
Alien Registration Number
Attach a Copy of the Chosen Document
Max. file size: 64 MB.
Given the percentage of ownership or stock owned or to be owned in the small business concern
Be sure to answer the following three questions correctly because they are important. The fact that you have an arrest or conviction record will not necessarily disqualify you, but an incorrect answer will probably cause your application to be turned down.
Are you presently under indictment, on parole, or on probation?
- Yes
- No
Provide details. List name(s) under which held, if applicable.
Have you ever been charged with or arrested for any criminal offense other than a minor vehicle violation?
- Yes
- No
Provide details. List name(s) under which held, if applicable.

Provide three personal references

Name	Phone

The information on this form will be used in connection with an investigation of your character. Any information you wish to submit that you feel will expedite this investigation should be set forth.
Name
First Last
Date*
MM slash DD slash YYYY
Authorization For Services And Waiver Of Liability
The Applicant on behalf of himself/herself (or Fill In #1 corporation or Fill In #2, a partnership) hereby requests Miami Bayside Foundation, Inc. to provide financial services. To assist Miami Bayside Foundation, Inc in providing said services, the Applicant agrees to furnish all information and documentation requested by Miami Bayside Foundation, Inc. and certifies that any information, documentation, and representations provided to Miami Bayside Foundation, Inc. will be true and correct. The Applicant agrees that any documents provided to Miami Bayside Foundation, Inc. will become the property of Miami Bayside Foundation. All information and data furnished by the Applicant will be treated as confidential provided that the Applicant authorizes Miami Bayside Foundation, Inc. and/or its affiliates, agents, and representatives to furnish information and data as necessary to local financial institutions in connection with related loans. The Applicant further agrees that Miami Bayside Foundation, Inc. may release such information whenever required by law, whether pursuant to a statutory provision through judicial or administrative order, or by legal proceeds. The Applicant hereby releases Miami Bayside Foundation, Inc., its officers, directors, employees, agents, and independent contractors which it employs (named “Protected Parties”) from any and all damage, claims, demands, and causes of action which the Applicant has or may have in the future against the Protected Parties by reason of any occurrences, including without limitation damages, injuries, and loses of any type or manner arising from any services which the Protected Parties provide or fail to provide under this authorization, including the release of information deemed confidential. The Applicant hereby agrees to indemnify and hold harmless the Protected Parties from any and all damages, claims, demands and causes of actions, including, but not limited to, amounts paid upon judgments, attorney’s fees, cost and amounts paid in settlement, reasonably incurred in connection with the defense or settlement of any claim, action, sort of proceedings in which any of the Protected Parties may be involved by virtue of services they provide or fail to provide on behalf of the Applicant pursuant to this authorization. The Applicant further agrees that in conjunction with this indemnification, the Applicant shall defend the Protected Parties at its own expense, specially including, without limitation attorney’s fees, court costs, expert’s fees. Investigation fees and expenses; provided however, that any counsel chosen by the Applicant must be acceptable to the Protected Parties involved in the particular litigation. It is understood that either Miami Bayside Foundation, Inc. or the Applicant may terminate the services provided hereunder at any time. It is further acknowledges that Miami Bayside Foundation, Inc. will provide the services as time permits. The Applicant clearly understands that in the event that Miami Bayside Foundation, Inc. issues a Commitment to Lend and it is executed by the Applicant, the Applicant agrees to pay a fee of 1% of the loan amount to cover closing costs and attorney’s fees.

Right To Financial Privacy Act Of 1987
This act was designed to protect the right to financial privacy. This is a notice to you, as required by the Right to Financial Privacy Act of 1978 of Miami Bayside Foundation, Inc.’s access right to financial records held by financial institutions that are or have been doing business with you, or your business, including any financial institutions participating in this loan, or loan guarantee in connection with this loan application. The Applicant further agrees to give Miami Bayside Foundation, Inc. access right continuously for the term of the approved loan without further notice as long as Miami Bayside Foundation, Inc. retains any interest in the loan. The Applicant further agrees to waive all rights derived from this Act and authorizes Miami Bayside Foundation, Inc. to use or transfer to the Government and all those financial institutions involved in this loan, all financial records, and to collect on a defaulted loan, or loan guaranty. The Applicant further agrees to authorize Miami Bayside Foundation, Inc. to advertise the approval of this loan in its outreach activities. No other financial records will be released by Miami Bayside Foundation, Inc., except as required or permitted by law.

Acknowledge
I (We) certify that I (We) have read and accept this notice and that I (We) have been given a copy of it. I (We) certify that the information contained in this form and all other statements and attachments to it, business and personal, pertaining to this case to be true and accurate.
Fill In #1*
Fill In #2*
Name*
First Last
Date*
MM slash DD slash YYYY
Business Plan For Compliance With Job Creation And Retention
Business Name*
Full Time Employees at Present*
Projected Full Time Employees Within Two Years from Loan Amount*
Total Number of Jobs Created*

List of Current Employees*

Full Name	Job Title	Annual Salary	Hours Per Week

Projected Employees*

Job Title	# of Employees	Full-Time, Part-Time, or Contract	Hours Per Week	Annual Salary	License/Education Required

Compliance Action Plan*
Please describe which actions will be taken by the business to ensure that low and moderate-income persons will receive first consideration for the jobs to be created.
I (we) certify that the information contained on this form is true and accurate.
Name*
First Last
Date*
MM slash DD slash YYYY
Inventory of Fixtures and Equipment Owned

Description	Serial Number	Year Purchased	Condition (new, fair, needs repair, etc.)	Estimated Current Value

Name*
First Last
Date*
MM slash DD slash YYYY
Request for Transcript of Tax Return
Request may be rejected if the form is incomplete or illegible.
Upload the 4506-T Form*
Max. file size: 64 MB.
Click here to download the 4506-T form from the IRS website.
Consumer Report Authorization
RE: Credit to be Extended to Fill In #1 ("Borrower")

The person(s) signing this letter is/are either principals or guarantors of the Borrower related to the loan which the Borrower has obtained from Miami Bayside Foundation or a loan for which the Borrower is applying. This letter serves as my/our authorization that is given to Miami Bayside Foundation, Inc. and its assigns (“MBF”) to obtain “consumer reports” and/or “investigative consumer reports” about me/us from any consumer reporting agency that MBF may choose to use and also to consider such reports when making any credit decisions regarding Borrower’s application for a loan, or Borrower’s performance of its obligations under any existing loan, or any modification of any existing loan. I/We acknowledge that there are various Federal and/or State laws such as the “Fair Credit Reporting Act” that control the issuance or use of “consumer reports” and/or “investigative consumer reports” by creditors. I/We understand that I/we are not obligated to provide MBF this authorization to review such “consumer reports” and/or “investigative consumer reports.” I/We agree that such reports can be released to MBF so that MBF will consider either the Borrower’s application for a loan, or the Borrower’s performance of its obligations under any existing loan, or any modification of any existing loan.

I/We hereby authorize MBF to obtain a “consumer report” or “investigative consumer report”, for credit evaluation purposes, whether or not subject to the Fair Credit Reporting Act. I/We authorize any person or entity contracted by MBF or anyone acting on their behalf, to furnish information regarding verification of my/our social security number, education, military record, motor vehicle reports, credit history, financial account balance, and history, professional licensures, public records, criminal record and/or employment references.

A photocopy, scan, or facsimile copy of this letter can be treated as though it were the original.
Fill In #1*
First Owner
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Second Owner
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Third Owner
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fourth Owner
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fifth Owner
Name*
First Middle Last
Social Security Number*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
By signing this form, you are agreeing to a charge of up to $30.00 (thirty dollars) for access to Triple-Bureau Report and Credit Scores. I understand these charges will post as a debit from the credit card listed below, and that I/We agree to the triple bureau credit report.

Billing Information
Credit Card Number*
CVV Code*
Credit Card Network*
- Visa
- Mastercard
- American Express
- Discover
Name as it Appears on Card to be Billed*
Date*
MM slash DD slash YYYY
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Requested Documents
Upload Requested Documents
Drop files here or

Max. file size: 64 MB.
Select the Documents You Have Uploaded
- Business Plan including corporate history and comprehensive marketing plan. Click here to download a business plan template.
- Resume of all principals.
- Three (3) years Profit and Loss Projections, monthly for one (1) year, and annually for the next two (2) years. Footnote assumptions. Click here to download a projection excel template.
- Detailed Use of Funds, including a breakdown of any line items over $5,000. Included on projection excel template.
- Business Financial Statements for the last three (3) fiscal years and year-to-date.
- Corporate Tax Returns (federal income tax) for the last three (3) years.
- Personal Income Tax Return filed for the last three (3) years.
- Six (6) months of supporting bank statements.
- Copy of Lease or Letter of Intent to Lease.
- Copy of Business Documents: Partnership Agreements, Articles of Incorporation, By-Laws, Certificate of Good Standing, etc.
- Copy of Local Business Tax Receipt.
- Proof of General Liability Insurance.
- Documentation of all Outstanding Debt Including Equipment Leases.
Please upload the following documents below. If any of the documents are not currently available, please email them to info@miamibaysidefoundation.org.
Name
This field is for validation purposes and should be left unchanged.

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Loan Application

Additional Documentation

Business Loan Application

Personal Financial Statement

Come Back to this

Statement of Personal History

Authorization For Services And Waiver Of Liability

Business Plan For Compliance With Job Creation And Retention

Inventory of Fixtures and Equipment Owned

Request for Transcript of Tax Return

Consumer Report Authorization

Requested Documents

Make a Donation

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