Name of project / transaction:*

Mailing Address
City
State
Zip Code

Contact Person*
Mailing Address
City
State
Zip Code
Phone*
Fax
E-mail

Developer or organizer of business/project

Mailing Address
City
State
Zip Code

Describe the project. You may provide a copy of your business plan or project proposal. Include information such as the primary business (manufacturer, retail, office building, warehouse distribution, etc.), number of employees, number of new jobs that will be created, new construction or building expansion, and new market opportunities. Please provide us any other information that you believe will be helpful in understanding your project.

Who controls business decisions?

Mailing Address
City
State
Zip Code

Total project cost

Please itemize your breakdown of sources and uses of capital for this project/business, including debt, equity, grants and tax increment financing. Identify lenders and investors if known. If not known, provide a reasonable projection of the terms of the debt financing and the method to be used to raise the equity (private placement/public offering/institutional).

What is the projected:
Closing Date for equity financing
Closing Date for debt financing
Completion Date of Project/Opening Date of Business

Submit

All information submitted will be held in the strictest confidence. Project selected for inclusion in the application submitted to the U.S. Treasury for an allocation of NMTC, will be described generally and will not be specifically identified without consent.