Rawlins County E-Fund Application
Rawlins County E-Fund Application
1. Applying Network Kansas Partner Organization
1. Network Kansas partner organization Rawlins County Economic Development___
2. Name of Primary Contact ______Julie Britton______
3. Title of Primary Contact ______Director______
4. Mailing Address ______406 Main, P.O. Box 403, Atwood, KS 67730_
5. Phone Number ______(785) 626-3640______
6. Fax Number ______(785) 626-3640______
7. Email Address ______
2. Client Information
8. Name of entrepreneur or small business______
9. If company, list entity type (LLC, sole proprietorship, etc.)______
10. Name of Primary Contact______
11. Title of Primary Contact______
12. Mailing Address______
13. Phone Number______
14. Fax Number______
15. Email Address______
16. Does the entrepreneur or small business owner have a tax liability in arrears with the Kansas Department of Revenue or the IRS? ______
17. Will the business be located in the same city listed in Question 12? ______
18. If No, list city where business is/will be located______
19. Are the funds for a business startup, or are they for the expansion of an existing business? Provide relevant details (length of time in business, business name or entity changes, etc.).
20. Tell about the business, its owners and key employees.
21. Provide projected sales, sales growth and any projected employment growth from this project.
3. Requested Funding Information
22. Amount of funding requested ______
23. Date Needed ______
24. Is the funding requested in the form of a Direct Grant or Loan? ______
25. If your answer to Question 23 requires additional explanation, provide it here.
26. Amount of funds being provided by private lenders ______.
27. List the percentage match and amount of funds being provided by the local and/or regional NetWork Kansas partners______.
28. Provide the terms of the agreement between the Rawlins County Economic Development and the client (client down payment, principal amount, loan or grant, length of loan, rate, etc.).
29. If the agreement between the Rawlins County Economic Development and the client is a loan; please list any fees required by the Rawlins County Economic Development to administer the loan that are to be paid by the E-Community (fee amount, reasons for fee, etc).
30. Explain specifically how the funds will be used by the client.
31. Describe any additional funding that will be utilized in this project.
4. NetWork Kansas Resource Partner Information
32. List other NetWork Kansas resource partners that have or will assist with this project and their role of contribution.
33. If other community organizations or community leaders not previously mentioned are involved or have expressed support, please explain.
34. List and describe any milestones for success that are planned to track the project.
35. Describe the benefits of the project to the community and the state of Kansas.
Marketing Release of Information
By submitting an application for financial assistance, the Client (prospective grant or loan recipient) agree to the following Marketing Release of Information* to be used by the Kansas Center for Entrepreneurship (dba NetWork Kansas) for the purpose of promoting the successful delivery of services to entrepreneurs and small business owners.
Marketing Release of Information*
Upon receiving notification that the Financial Advisory Committee has selected the Client to receive financial assistance, the Client agrees to provide pertinent information to the NetWork Kansas Marketing Manager and/or Director for the purpose of preparing a news release for distribution to other Resource Partners and media outlets as determined by the NetWork Kansas Marketing Manager;
Information for the news release will be obtained primarily from the E-Community application, the Resource Partner and grant/loan recipient’s Web sites and previously published information, and by phone interviews with representatives of both parties;
NetWork Kansas will make accommodations to withhold all information identified by the Client as being sensitive or competitive in nature, particularly when this information is not previously published and therefore not already considered to be in the public domain. All parties named in the release will receive a final copy of the news release prior to distribution in order to verify the accuracy of all information contained therein;
NetWork Kansas will disseminate a news release and related information to external media outlets only after the loan or grant is approved and closed by the NetWork Kansas partner administering the E-Community program;
In addition to disseminating the resulting news release to media outlets, NetWork Kansas may distribute all or part of the news release and related information to organizations, networks and individuals via Email, NetWork Kansas and third-party Web sites, blogs, instant messaging, chat rooms, message boards, et...
- I have read and agree to the terms described in the Marketing Release of Information
Declaration.
Yes______No______
Rawlins County E-Fund Financial Advisory Board
a) Chris Sramek, Owner Decision Weather, Rawlins County Economic Development Board, 785-626-8066,
b) John Buck, President of The Bank – Atwood, Rawlins County Economic Development Board, Rawlins County Micro-Loan Committee, 785-626-3226
c) Barney Horton, President of Farmers Bank & Trust, Rawlins County Economic Development Board, Rawlins County Micro-Loan Committee, 785-626-3233
d) Jayne Niermeier, Manager, The Bank – Herndon, Rawlins County Economic Development Board, 785-322-5619,
e) Bob Dunker, Owner Dunker’s Radio & TV – Atwood Cable Systems, Rawlins County Economic Development Board, 785-626-3261
f) Linda Wright, Office Manager Midwest Energy, Rawlins County Economic Development Board, 785-626-3231
g) Tim Colgan, Owner – Tim’s Electric & Remodeling, Rawlins County Economic Development Board, 785-626-9629