ReEnergize Ohio Borrower Application

Tell us about your bank...

Bank:
Loan Officer First Name:
Loan Officer Last Name:
Loan Officer Phone Number:
(e.g. 000-000-0000)
Loan Officer Email:
*Please contact your bank loan officer prior to completing this application to negotiate the loan and tell them you want to use the ReEnergize Ohio Linked Deposit program. If you or your banker have questions about this, please call 614-466-6546.

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:
*Please provide an email address to receive application progress and approval notifications.
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

Required: Provide a project summary that explains what will be done with the proceeds of the loan. If your project has more than two areas receiving improvements, please attach a more detailed project description that identifies the products and materials with costs for each part of the overall project.
Estimated Project Completetion Date:
Total Amount of Bank Loan:
$
File 1
File 2
File 3
File 4