Intake Form

  • LOAN REQUEST INFORMATION

  • BUSINESS OWNERSHIP

  • Provide names and percentages of ownership for each person owing at least 20% of the business. If no one person owns at least 20%, list the information for the five people who own the largest shares or hold the highest position.
    NameTitle/Position% of Business OwnedYears with the Business 
  • THIS IS FOR INFORMATIONAL PURPOSES ONLY. IT IS NOT A LOAN APPLICATION. IMPORTANT! READ THIS BEFORE SIGNING

    The collection of this data is not to be considered an application for a PIDA loan. Following receipt of a fully completed Intake Form, Regional Industrial Development Corporation of Southwestern Pennsylvania (“RIDC”) will determine, and the Applicant will be notified in writing, whether or not RIDC wishes to move forward with an Application for a PIDA Loan. SUBMISSION OF A LOAN APPLICATION IS NOT A GUARANTEE OF FUNDING BY PIDA. I verify that I am authorized to commit my organization and to submit this Intake Form on behalf of the organization. I certify that the above information is correct and that the statements made herein are true and correct to the best of my knowledge. I understand that this Intake Form or a subsequent Application may be disqualified if it does not contain all required information. I understand that all materials submitted as part of the Application are subject to disclosure. I acknowledge and agree that (1) RIDC has no obligation, and retains the sole discretion whether or not to proceed with a PIDA Loan Application and (2) submission of this Intake Form and any subsequent PIDA Loan Application, does not imply any promise of funding at any time.
  • MM slash DD slash YYYY