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PO Box 661
Fort Washakie WY 82514
P (307) 335-7330
F (307) 335-7332
Internal
Business Loan Application Type
Startup Existing
Applicant Information





(include area code)

(include area code)












Employment & Income



(include area code)





You are not required to list alimony or child support unless you want them considered for repayment ability.



Co-Applicant Information
Spouse Family Member Non-Family Member Brother Sister Adopted Family





(include area code)

(Include area code)





Wind River Development Fund is an equal opportunity lender. WRDF does not discriminate on the grounds of race, color, religion, gender, marital status, disability, or national origin.

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Business Information















(enter only a number)


(if known)

(including yourself)



Bank Information





Use of Proceeds - Enter the Amount Requested
$
$
$
$
$
$
$
$
$
$
$
$
$


$

Collateral


$

Personal Financial Statement

Assets Balance (omit cents)
LIQUID ASSETS
$
$
$
INVESTMENT ASSETS
$
$
$
$
$
PERSONAL ASSETS
$
$
$
$
$
$
Liabilities (omit cents)

SHORT-TERM LIABILITIES

$
$
$
$
$
$
$

LONG-TERM LIABILITIES

$
$

$

$
Notes Payable to Banks and Others (list each notes payable separately)


$

$








Legal






Demographics
Please complete this section to your comfortability. If you choose not to answer, please select "No Reply".






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Small Business Loan Checklist

$5,001.00 - $250,000.00 Loan
1. BUSINESS PLAN
Attach a written business plan and include the following:
  • Business description
  • Management qualifications
  • Operating plan
  • Marketing plan
  • Balance sheet (for existing businesses)
  • Financial projections
  • Start-up costs (for new businesses)

2. COPY OF PHOTO ID

3. PERSONAL TAX RETURNS OR DOCUMENTATION
Attach federal tax filings for the last three years for each stockholder, partner, officer, owner, or guarantor.

4. BUSINESS TAX RETURNS OR DOCUMENTATION
Attach federal tax filings for the last three years (if applicable)

5. 60 DAYS OF PERSONAL BANK STATEMENTS

6. 60 DAYS OF BUSINESS BANK STATEMENTS
If applicable.

7. PURCHASE AGREEMENT
If you are buying real estate, machinery, equipment, or an existing business with your loan money, please attach a listing, purchase agreement or contract, including the seller's name and contact information

8. CONSTRUCTION PLANS AND PROJECT COST
For construction loans, please upload an estimated cost of the project and statement of source for additional funds. Also, please upload a preliminary construction plan as prepared by a qualified, independent third party such as a contractor or architect.

AUTHORIZATION

By signing this application, I request business counseling service from Small Business Administration (SBA) or Community Navigator. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.) I authorize SBA to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees not to: 1) recommend goods or services from sources in which he/she has an interest, and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against SBA personnel, and that of its Community Navigator and host organizations, arising from this assistance.
Please submit this application with any additional information requested
I/We authorize the Wind River Development Fund to make inquires as necessary to verify the accuracy of the statements made and to determine my creditworthiness. The undersigned authorize any person or consumer reporting agency to give you any information it may have on the undersigned. Each undersigned authorizes you to answer questions about your credit experience with the undersigned. The undersigned, is applying for financial assistance from the Wind River Development Fund, recognizes that prior to receiving any financial assistance he or she will agree to comply with all federal, tribal, state and local laws & regulations to the extent that such are applicable. I understand FALSE statements may result in forfeiture of benefits and possible prosecution.

AUTHORIZATION TO RELEASE INFORMATION

I have applied for assistance or obtained a loan from Wind River Development Fund (WRDF).  As part of the process, WRDF may verify information contained in my request for assistance and in other documents required in connection with the request.

I authorize you to provide to WRDF for verification purposes the following applicable information:
  • Past and present employment or income records.
  • Bank account, stock holdings, and any other asset balances.
  • Past and present landlord references.
  • Other consumer credit references.
I further authorize WRDF to order a consumer credit report and verify other credit information so that we can assess and support my asset building progress with WRDF. I acknowledge that this credit report request will appear on my record and is done in this way to receive my credit score and full report.

I understand that under the Right to Financial Privacy Act of 1978, 12 USC 3401, et seq., WRDF is authorized to access my financial records held by financial institutions in connection with the consideration or administration of assistance to me.  I also understand that financial records involving my loan and loan application will be available to WRDF without further notice or authorization, but will not be disclosed or released by WRDF to any other person or agency without my consent except as required or permitted by law.

The information WRDF obtains is only to be used in the processing of my request for assistance. A copy of this authorization may be accepted as an original.






(if included in Personal Financial Statement)