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
Contact Title
Email Address
Phone Number
Company Address
City
State
Zip
Company Information
Industry
The company is
For-profit
Nonprofit
Revenues in last fiscal year
Current Revenues
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
Branch Location
Lender First and Last Name
Lender Phone Number
Lender Email Address
Loan Type
Line of Credit
Term Loan
Other
Loan Amount
Interest rate
Numbers only
Project Sources and Uses
Please itemize the borrower's use of loan proceeds (include dollar amount and source) For example, "
Building, $25,000
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?
Yes
No
Please explain how the business has been negatively impacted by COVID-19
Supplemental Documents
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 edd-finance@state.nm.us.
Lending institution Credit Memo/Analysis
Additional Documents
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.
Authorization
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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Contact Information