Nebraska Enterprise Fund Streetcar Business Impact Fund Phase 2 Application

Business Legal Name and DBA *

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

Include street, apartment or suite (123 Main St, Suite 100)

Business Phone Number *

Business Email *

Business NAICS Code *

Business Annual Gross Revenue *

Number of Full Time Employees *

Number of Part Time Employees *

Type of Streetcar Business Impact Funds you are Applying for? *

up to $10,000 Grant
up to $50,000 Forgivable Loan

Check all that apply

Describe your previous funding due to impact of the Streetcar. *

For example: $5,000 from the Chamber of Commerce.

Applicant Name *

First

Last

Applicant Address *

Address Line 1

Address Line 2

City

State

Zip Code

Applicant Email *

Cell Phone Number (no dashes/spaces) *

Do we have your permission to text you with updates? *

Social Security Number *

Please enter your SSN with in NO dashes.

Applicant/Owner Percentage of Ownership *

Applicant/Owner Gender *

Applicant/Owner Ethnicity *

Applicant/Owner *

Please check all that apply

Please upload a picture of your Driver's License. *

Drag & Drop Files, Choose Files to Upload

Please upload a SIGNED and DATED copy of your W9 Document. *

Drag & Drop Files, Choose Files to Upload

PDF format is preferred but you may also take a picture to upload.

Do you prefer a Wire Transfer or a Check? *

NOTE: A Wire Transfer is required for all Loans.

Please upload Wire Transfer instructions on your bank's letterhead.

Drag & Drop Files, Choose Files to Upload

PDF format is preferred but you may also take a picture to upload.

What Services are you looking for? *

Describe the intended use of Streetcar Business Impact Funds.: *

Signature (Use your finger or mouse to sign below) *

Clear Signature

By signing above, I am requesting business assistance in the form of grants, a micro-loan, training, and/or business technical assistance or counseling from the Nebraska Enterprise Fund or one or more of its program partners. I agree to participate should I or my business be selected to participate in follow-up surveys designed to evaluate NEF or its partner services. I understand that any information disclosed will be held in strict confidence by NEF staff, the NEF loan committee and by any NEF resource partner. In consideration of the counselor(s) working for NEF or its partners furnishing management or technical assistance, I waive all claims against NEF personnel, and that of its resource partners and host organizations, arising from this assistance. Meeting these criteria makes a business eligible to apply, not guaranteed to receive funds.