Queen Anne's County Small Business Assistance & Recovery Fund Application

Required Documents:

Completed Application
U.S. Tax Return for 2019 as filed with IRS or 2018 if 2019 not yet filed.
2019 Income Statement and Balance Sheet for Business if 2019 tax returns not filed.
2020 Year to date Income Statement and Balance Sheet.
If seeking assistance with payroll costs please provide the first page of the last 4 quarters of your Maryland Unemployment Quarterly Contribution Report.
Personal Financial Statement for each owner with 20% or more ownership interest. Guarantees will be required on for profit entities.
Articles of Incorporation/Organization/Formation and operating agreement if applicable.
Additional information can be found in the Frequently Asked Questions document and on our website www.choosequeenannes.com

Business Name:

Business Address:

Address or Location

Business Federal Employer ID#

First Name

Last Name

Primary Contact Address

Address or Location

Work Phone:

Cell Phone

Website

Email:

Is your Business Located In Queen Anne's County?

******ATTENTION*******

Your business must be located in Queen Anne's County to be eligible!

Please exit the application!

Physical Address of Business:

Address or Location

Type of Product or Service: i.e. restaurant, manufacturer of widgets, wholesaler of widgets, janitorial service

Briefly describe business (100 words or less)

NAICS Code see application instructions for help on finding your NAICS Code.

Was your business established before 12/31/19?

******ATTENTION*******

Your business had to be established before 12/31/2019 in Queen Anne's County to be eligible!

Please exit the application!

Years in Business

Is your business in good standing with the State of Maryland?

******ATTENTION*******

Your business must be in good standing with the State of Maryland to apply.

Please exit the application!

Have you applied for the SBA EIDL?

Where you awarded funds?

Amount Awarded

Date Received

Have you applied for the Payroll Protection Program through your Bank?

Where you awarded funds?

Amount Awarded

Date Received

Have you applied for other Covid relief funds?

Where you awarded funds?

Please provide information such as Source and use of funds

Amount Awarded

Date Received

Have you received relief from landlord, bank or other creditor?

Please include from whom, amount and length of time.

Prior to Covid-19 did the business have any employees?

How many full time employees?

How many part time employees?

Do you currently have employees?

How many full time employees?

How many part time employees?

How many of your current employee's are Queen Anne's County Residents?

Unpaid Taxes: Please list any unpaid Federal,State,Local or Other taxes. Please List the Type,Amount, Amount Past Due and Payment Terms.

Does your business have any outstanding, pending or anticipated claims, liens, judgments or litigation against the applicant?

Please explain any outstanding, pending or anticipated claims, liens, judgments or litigation against the applicant.

Has the business declared bankruptcy in the past?

If the business declared bankruptcy in the past please explain and include date.

Has business defaulted on loan in the last 3 years?

Please provide details of lender, type of loan amount defaulted and status

Has the business ever received a loan or grant from Queen Anne's County?

Please provide information regarding the loan or grant including the Amount,Date and Type.

Has the business ever defaulted on a loan or grant from Queen Anne's County?

Please provide details of the defaulted loan or grant.

Please note that most grants will be no more than $10,000

Use of funds can include the following

Purchase of personal protective equipment and other supplies necessary to meet CDC requirements
Costs related to necessary adjustments to meet social distancing recommendations.
up to one-month payroll expenses
up to 3 months business rent
inventories and supplies necessary to reopen or restock business
other critical operating expenses

Please provide your one month payroll expenses including employer portion of payroll taxes.

How many employees will be paid with these funds.

What is your monthly rent payment for your business location?

Number of months for Rent

Total (up to 3 months) rent requested

Please enter an amount for Inventory and/or supplies

Please enter an amount for costs related to social distancing requirements.

Please enter an amount for PPE

Did the business have any other critical operating expenses?

Yes

Please explain other critical operating expenses

Please list the amount of the other critical operating expenses.

Here is the total amount of Covid-19 related operating expenses ( The amount will be calculated automatically)

Please enter your Grant Request Amount

Please provide proof of business disruption due COVID-19. Include details such as was your business closed and for how long, staffing issues, estimated revenue loss,supply and inventory issues etc.

Please upload your U.S. Tax Return for 2019 as filed with the IRS or 2018 if 2019 not yet filed.

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Please upload your 2019 Income Statement and Balance sheet for Business if 2019 tax returns not filed

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Are you applying for more than $10,000 assistance?

Please upload personal financial statement for each owner with 20% or more ownership interest

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Please upload your 2020 Year to date Income Statement and Balance Sheet.

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Please upload articles of Incorporation/Organization/Formation and operating agreement if applicable.

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If you have any additional documentation or support please upload here.

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If applying for payroll assistance pleae provide last 4 QTRS of MD Unemployment Quarterly Contribution Reports or 941's

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Please sign here to complete your application.

First Name

Last Name

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All information in this application and in the attached exhibits, attachments, and addendums are true and complete to the best of my/our knowledge, information, and belief