We would like a loan to repair or replace property, fixtures or equipment where claims will be filed with private or government insurers or against expected reimbursement from government contracts, foundation or corporate grants, or individual support; necessitated by administrative/operational disruptions, service delivery disruptions, or disruptions in claimable/chargeable activities.

Our documented losses are*

Of that amount, is for property, fixtures or equipment damage.

Of that amount, is for business interruption.

In your own words, briefly describe where you are located, what you do, how your organization and facilities were affected by Sandy, where you are at this juncture, and what are the most significant current dislocations.

We have applied to FEMA*   Yes No

FEMA has visited times.     Date of most recent visit:

We expect to receive FEMA Project Worksheets in   March  April  May  June  later 

We have private insurance*   Yes No

Our insurers are covering flood damage    Yes No

Amount expected from insurance:

We have applied for an SBA Loan*   Yes No     Date:
 

Legal Name of Organization:*

Tax ID Number:*

Person filling out this loan request:* Title:*

Email:* Telephone:* Fax: