ReEnergize Ohio Borrower Application

Tell us about your bank...

Bank:
Lender First Name:
Lender Last Name:
Lender Phone Number:
(e.g. 000-000-0000)
Lender Email:

Tells us about your business...

Business Name:
Owner First Name:
Owner Last Name:
Address:
Address 2:
City State Zip
County:
Website:
Phone:
(e.g. 000-000-0000)
Fax:
(e.g. 000-000-0000)
Email:
Does the company employ less than 150?
Is the company headquartered in the State of Ohio?
Does the company maintain offices and facilities in Ohio?
Are the majority of employees Ohio residents?
Is the company organized for profit?
Have you previously participated in any of the State's Linked Deposit Programs?
If yes, what program and when?
Is owner a veteran or a surviving spouse of a veteran?
How did you hear about this program?
What is the approximate size of the building or office?
What year was the building or office built?
Number of employees on payroll?
How many jobs will this project create or retain?
Please explain the type of business:

Project Information

Contractor 1:
Name
Address:
Address 2:
City State Zip

Phone
(e.g. 000-000-0000)
Fax
(e.g. 000-000-0000)
Email



Project Description
Estimated Project Completetion Date:
Cost of Energy-Efficient Improvements:
$
Total Amount of Bank Loan:
$
File 1
File 2
File 3
File 4