P. O. Box 330 200 E Central Avenue Bentonville, AR 72712 479.273.2841 FAX 479.273.2180 www.bbvchamber.com Notice of Intent to Apply North Walton Boulevard Loan Consortium Applicant’s Name _______________________________________________________ Address _______________________________________________________________ City, State, Zip _________________________________________________________ Telephone _______________________ Cell # ________________________________ Principal in Charge ______________________________________________________ Contact Person Telephone (if different from above) _____________________________ FULL PROJECT NARRATIVE (Use Additional Sheets as Neccessary): ___________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ PROJECT FINANCING: NWBLC Loan $____________________________ OTHER FUNDS (List Source and Amount) _____________________________________ _____________________________ _____________________________________ _____________________________ _____________________________________ _____________________________ _____________________________________ _____________________________ TOTAL $____________________________ 1. Is the proposed occupant of the project different from the proposed owner of the project? ( ) YES ( ) NO If yes, list both occupant and owner. ______________________________________________________________________ ______________________________________________________________________ 2. Will the proposed occupant be operating under a franchise agreement? ( ) YES ( ) NO PROJECT SITE (LAND): 1. Size (in acres) of project site: ________________________ 2. Are there buildings now on the project site? ( ) YES ( ) NO 3. Indicate in detail the present use of the project site: ___________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 4. Indicate present owner of project site ______________________________________ 5. If applicant now owns project site, indicate: a. Date of purchase_________________________________________________ b. Purchase price__________________________________________________ d. Holder of mortgage_______________________________________________ 6. If the applicant is not the owner of the project site, does applicant have an option to purchase the site and any buildings on the site? ( ) YES ( ) NO 7. Has the applicant entered into a contract to purchase the site? ( ) YES ( ) NO 8. If the applicant is not the owner of the site, does the applicant now lease the site or any buildings on the site? ( ) YES ( ) NO If yes, include a copy of the lease. 9. Is there a relationship legally or by virtue of common control between the applicant or proposed user of the project, and the seller of the project? ( ) YES ( ) NO If yes, describe the relationship, using an attachment if necessary. BUILDINGS: 1. Does the project involve acquisition of an existing building or buildings? ( ) YES ( ) NO. If yes, indicate the number and size of buildings. _________________ ______________________________________________________________________ 2. Does the project consist of the construction of a new building or buildings? ( ) YES ( ) NO. If yes, indicate the number and size of new buildings and provide any preliminary designs. _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 3. Does the project consist of additions and/or renovations to existing buildings? ( ) YES ( ) NO. If yes, indicate nature of expansion and/or renovation and include any preliminary designs. _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________ PROJECT COST: State the costs reasonably necessary for completion of the proposed project associated with this loan application using the following categories: Land $_____________________ Buildings ___________________ Other (Specify) ___________________________ ___________________ TOTAL PROJECT COST $__________________ EMPLOYMENT IMPACT: Indicate below the number of people presently employed at the site of the project, and the number that will be employed at the site at the end of the first and second year after the project has been completed (do not include construction workers). Current Employment: ___________________ (Projected) First Year: ___________________ (Projected) Second Year: _________________ SIGNATURE: __________________________________________________________ NAME (PRINT): ________________________________________________________ TITLE: ________________________________________________________________ DATE: __________________________________ Please submitted the completed Notice of Intent to Apply to Dana D. Davis, IOM, CEO/President, Bentonville/Bella Vista Chamber of Commerce, P.O. Box 330, 200 E. Central Avenue, Bentonville AR 72712 or [email protected]. The BBV Chamber reserves the right to request additional information as they consider the qualification of applicant and project for participation in the North Walton Boulevard Loan Consortium. A letter from the BBV Chamber approving the filing of an application with the North Walton Boulevard Loan Consortium is required prior to the submission of the official application.
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