Business owner name(s): *

Address: *

Email Address: *

Phone *

Business name: *

Business Start Date: *

Business Address: *

Website:

Business Hours: *

Type of business: *

1.

Capital improvement estimates: please upload contractors bid (if avaliable)

20MB max

Roofing:

Plumbing:

HVAC:

Electrical:

General carpentry (paint, carpet, etc.):

2. *

Provide breakdown of how this venture will be funded (e.g. loan, grants, personal income, etc.)

3.

Provide name of financial institution that will be financing the project, name of the loan officer and contact information.

ADDITIONAL INFORMATION *

It is at the sole discretion of the Grantor to approve or deny any application. Applications will be evaluated using but not limited to information contained in this Application. Completion of this Application does not entitle the Applicant to Grant funds.

GRANT REQUEST FORMULA: *total grant not to exceed $25,000 *

Criteria	Projections	Multiplier	Amount Requested
Capital improvements		x 20%
FF&E (furniture, fixtures & equipment)		x 20%
Monthly rent/mortgage payment		x 3
Total:		N/A

Capital Improvements *	FF&E *	Monthly rent/mortgage payment *
			Del

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Employees: *

Projected number of employees: *	Projected wages/salaries: *
		Del

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Borrower's Signature Authorization Form: *

I hereby authorize the Marshalltown Area Chamber of Commerce “grantor,” to discuss and verify my financing for the proposed business venture with my lender. Discussions will be used to facilitate and validate this grant application. I understand that if a grant is awarded, funds will not be released until a Certificate of Occupancy is issued and provided to the Chamber. I understand the grant may be assigned to my lender

Additional Information *

It is at the sole discretion of the Grantor to approve or deny any application. Applications will be evaluated using but not limited to information contained in this Application. Completion of this Application does not entitle the Applicant to Grant funds.

Applicant shall defend, indemnify and hold harmless Grantor, Protected Parties, board members of grantor, employees of Grantor, volunteers for Grantor and other agents of Grantor (the “Protected Parties”) from and against any and all claims (and all related liabilities, costs, and attorneys’ fees) arising from (a) Applicant’s use of grant funds for anything done, permitted, suffered or omitted by Applicant or any of its agents or visitors in or about property owned or rented by Applicant, whether real or personal, in which funds from this Grant may have been used, and/or (b) any breach or default by Applicant hereunder. As a material part of the consideration to Grantor, Applicant hereby assumes all risk of damage to property or injury to persons from property whether real or personal, which is owned or leased using grant funds and waives all claims against Grantor and/or the other Protected Parties on account of the same.

Applicant’s obligation to indemnify and hold harmless Grantor, Protected Parties, board members of grantor, employees of Grantor, volunteers for Grantor and other agents of Grantor, shall survive the expiration or termination of this Grant or the use of the Grant funds.

Redress for any claim against Grantor under this Application shall be limited to and enforceable only against Grantor to the extent of Grant amount. The obligations of Grantor under this Application are not intended to and shall not be personally binding on, nor shall any resort be had to the private properties of any Protected Parties, board members of grantor, employees of Grantor, volunteers for Grantor, or other agents of Grantor