SAVE Application | Hugo Area Chamber Of Commerce

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SAVE Program Application

SECTION 1 - Business Information

Business Name*

DBA (If Applicable)

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Mailing Address (If different from physical address)

Email*

Phone*

Website

SECTION 2 - Business Ownership

Owner/Primary Contact Name*

Position/Title

Phone:

Email:

Business Structure

Sole Proprietorship

Partnership

Corporation

LLC

Other

Business Start Date

Federal EIN / Tax ID

State Business License/Registration #

SECTION 3 - Business Operations

Brief Description of Business/Services Provided

Number of Employees (including owner)

Average Monthly Revenue (past 3 months)

Has your business received financial assistance from this program before?

Yes

No

Type of Assistance Requesting (check one NOTE THOSE COULD CHANGE BASED ON POLICIES)*

Rent/Lease

Utilities (electric, water, gas, internet)

Payroll Costs

Vendor Invoice

Essential equipment repairs or replacement

Other

SECTION 4 - Assistance Request

Amount Requested

What is the time frame of needed funds?

Vendor/Creditor Name

Vendor/Creditor Mailing Address

Vendor Phone

SECTION 5 - Financial Hardship Explanation

Please describe the financial hardship your business is experiencing and how this assistance will help sustain operations.*

SECTION 6 - Required Documentation Checklist

Completed Application Form

Documentation of financial hardship (e.g., financial statements, hardship explanation)

Copy of current business license/registration*

Proof of ongoing business activity (sales receipts, tax return, or bank statement)*

Copy of the bill or invoice needing payment*

Other (ex. financial statements)

SECTION 7 - Certification and Agreement

Add I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in denial or termination of assistance, and that funds received must be applied directly to the approved business expense.

I further authorize Hugo Area Chamber of Commerce “Mind Your Business” SAVE program to verify any information provided, including contacting vendors or creditors listed in this applicationyour text

Signature*

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Please Print Name*

Date and time*

Month

Day

Year

Time

:HoursMinutes

Need Help?

Please connect for SAVE Application assistance.

580-326-7511

chamber of commerce

200 S Broadway St, Hugo, OK 74743

Monday 9 AM – 4  PM

Tuesday 9  AM – 4  PM

Wednesday 9 AM – 4  PM
Thursday 9 AM – 4  PM
Friday 9  AM – 12  PM

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