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PPP Loan Forgiveness Application - Front page

Paycheck Protection Program loan Forgiveness Application Revised June 16, 2020 OMB Control Number 3245-0407 Expiration Date: 12/31/2023 PPP loan Forgiveness Calculation Form Business Legal Name ( Borrower ) DBA or Tradename, if applicable Business Address Business TIN (EIN, SSN) Business Phone ( ) -Primary Contact E-mail Address SBA PPP loan Number: Lender PPP loan Number: PPP loan Amount: PPP loan Disbursement Date: Employees at Time of loan Application : _____ Employees at Time of Forgiveness Application : EIDL Advance Amount: EIDL Application Number: Payroll Schedule: The frequency with which payroll is paid to employees is: Weekly Biweekly (every other week) Twice a month Monthly OtherCovered Period: to Alterna

through the date of this application. SBA may direct a lender to disapprove the Borrower’s loan forgiveness application if SBA determines that the Borrower was ineligible for the PPP loan. Signature of Authorized Representative of Borrower . Date . Print Name . Title . SBA Form 3508 ( 06/20) Page 2 _____

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