COVID-19 Business Loan Guarantee Program
Loan Enrollment Form, Online Application
Borrower Personal Information
**PLEASE NOTE: THIS FORM SHOULD BE FILLED OUT BY THE LENDER
Legal Company Name
Contact First Name
Contact Last Name
The company is
Revenues in last fiscal year
Year business started
Number of employees, FT/PT (now and prior to impact)
Potential Economic Impact Information
Current # of full-time employees
Current # of part-time employees
Note: Full-time is more then 2,000 hours per year; part-time is less then 2,000 hours per year; created or retained jobs must be within New Mexico.
Loan and Lender Information
Lending Institution Name
Lender First and Last Name
Lender Phone Number
Lender Email Address
Line of Credit
Project Sources and Uses
Please itemize the borrower's use of loan proceeds (include dollar amount and source) For example, "
What is the requested guarantee amount from NMEDD?
For what amount of time is the guarantee needed? NMEDD's guarantee can be in place for up to 2 years, reviewed at every 6 months.
Please explain why the lending institution is unable to make the loan without the NMEDD financial support?
Has the business been negatively affected by COVID-19?
Please explain how the business has been negatively impacted by COVID-19
Accompanying this application please provide the following supplemental documents on the project:
1. Lending institution's Reduced Scope Credit Memo/Analysis Please upload below. Please send questions to email@example.com.
Lending institution Credit Memo/Analysis
The checkbox and fields below affirms that the Lender certifies that the information in this Loan Enrollment Form and Eligibility Questionnaire is true and accurate to the best of their knowledge and belief.
I certify that the information in this form is true and accurate to the best of my knowledge
Name and Title
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