INNOVATION LOAN FUND APPLICATION (LIFT)
BANK OF NORTH DAKOTA
General
General
Applicant Name
*
Social Security # (SSN)/Federal Tax Id #
Primary Contact First Name
Primary Contact Last Name
Primary Contact Title
Address
City
State
Select One
ND
AB
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AR
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IL
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YT
Zip Code
Telephone Number
Email Address
Section
Legal Structure
Corporation
General Partnership
Limited Liability Company
Limited Partnership
Non-Profit
Sole Proprietorship
Sub Chapter S Corporation
Business Status
New
Existing
Purchase Existing
Date Business Established
Section
Project Description
Current Number of Employees
Projected Number of Employes (within 24 months)
Current Average Wage Plus Benefits
Projected Average Wage Plus Benefits (w/i 24 mo)
MARIJUANA RELATED BUSINESS ACTIVITIES
Section
Will loan proceeds be used for any marijuana related business activities?
Yes
No
Does the borrower or co-borrower generate revenue from marijuana related business activities?
Yes
No
If yes, what percentage?
Borrower(s) will notify BND if they become involved in any marijuana related business activities?
Yes
No
I/We certify that the Marijuana Related Business Activities questions above are true and correct as of the date of this application.
Please initial here:
*
Section
Section
Applicant Name
*
Signature
Signature Date