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.