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2. Thank you for your interest in applying for the Shaker Partnership Loan. Completing this form is the first step in the process. Once you submit the form, a member of the City's Economic Development Dept. will be in touch. If you have any questions about this application or the Shaker Partnership Loan, please contact the Economic Development Specialist.

    

4. Business Owner Name*
6. Business Owner Phone*
7. Business Owner Email*
9. Current Mailing Address*
11. Business Name (DBA)*
13. Legal Entity Name*
15. Shaker Business Address (Proposed or Current)*
17. Lease Term*
    Indicate proposed term for new location; remaining term on current location; or if the property is owner occupied.
19. Business Phone*
20. Business Website*
22. Business Social Media Links*
    If no social media, type "none."
24. Project Description*

    Describe how you will use the funding.

26. Total Estimated Project Cost*
28. Have you applied for commercial bank financing?*

    1. Yes

    1. No
29. If yes, what was the outcome?
31. Preferred Lender*
33. How much equity are you willing you put toward the project cost?*
35. Total revenue last year.*
    Indicate start up if no revenue.
36. Current payroll.*
38. Current number of full-time employees.*
39. Current number of part-time employees*
41. Percentage of business that is minority owned?*
42. Certifications

    1. Small Business Enterprise (SBE)
    2. Minority Business Enterprise (MBE)

    1. Female Business Enterprise (FBE)
    2. EDGE

    If you would like to learn more about becoming certified, please contact Georgina Figueroa in the City's Economic Development Dept.

44. Projected Payroll
46. Year 1*
48. Year 2*
50. Year 3*
52. Year 4*
54. Year 5*
56. Full-time jobs created as a result of this loan.*
57. Part-time jobs created as a result of this loan.*
59. Small Business Development Center Referral
61. I have been explained the required consultation and referral requirements to the SBDC for technical assistance?*

    1. Yes
    2. No
62. Do you have a preference for the SBDC you work with?*

    1. Yes
    2. No

    If you would like more information on local SBDCs, review this list of participating SBDCs and their contact information. 

64. If yes, please indicate your preferred SBDC
    -- Select One --Cleveland State University SBDCECDI/Women's Business CenterNortheast Ohio Hispanic Business CenterOhio SBDC at the Urban League
66. Acknowledgements
68. Applicant acknowledges the following:*

    You must check each box to be considered.

    1. I am ready and able to contribute the 10% equity injection requirement.
    2. I may work with anyprivate lender.
    3. I understand that the City reserves the right to reject any application that does not meet the program requirements or goals.
    4. I understand that the City may award a partial forgivable loan (up to 15% of the project cost) based on available funding or other factors.
    5. I understand that I am required to seek technical assistance from an SBDC before receiving a forgivable loan from the City of Shaker Heights.
    6. I understand that I must seek technical support annually from a business support organization of my choosing during my contract term.
    7. I must provide a business plan, including financial projections, with this intake form.
    8. I understand that City of Shaker Heights staff will review this Intake Form and provided Business Plan/financials to determine if a forgivable loan agreement can be pursued.
    9. I understand that completion of this intake form does not commit any type of award or benefit and a separate agreement will be required.
    10. I understand that the Shaker Partnership forgivable loan funds are available on a first-come, first-serve, competitive basis and are limited.
70. Business Plan Upload*
72. Additional Document Upload (Optional)
    E.g. financials, marketing materials, menu, etc.
74. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
76. Electronic Signature*
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field