Application
Section 1: Applicant Information
Name of Owner(s): *
Your answer
Street *
Your answer
City *
Your answer
Zip *
Your answer
State *
Your answer
Phone *
Your answer
Email *
Your answer
Section 2: Business Information
Farm name *
Your answer
Business Street
(if different from applicant mailing address)
Your answer
Business City
Your answer
Business State
Your answer
Business Zip
Your answer
Business Phone
Your answer
Business Email
Your answer
Business Website
Your answer
Type of business: *
Legal Name of Borrower *
(This could be your farm business or you as an individual.)
Your answer
Section 3: Overview of your business
Please provide a basic description of your business, including a brief history, ownership and management, products, and markets. *
(recommended 300 words or less)
Your answer
What were your gross annual sales in 2017? *
Your answer
Are you a limited resource farmer? (optional)
Check yes if, for both 2016 and 2017, your gross farm sales were no more than $177,300 AND your total household income was less than $29,943 for Franklin County, $27,319 for Hampden County, or $34,116 for Hampshire County.
Section 4: Description of damage to crops as a result of extreme weather in 2018
Please describe the damage done to your farm, and list the monetary losses caused. *
(recommended 200 words or less)
Your answer
What is the estimated monetary loss? *
Your answer
Section 5: How would you use the loan?
Loan Amount Requested $ *
Must be less than or equal to the amount in the previous question (Section 4).
Your answer
Please provide a brief description as to how the funds would be utilized and how this would benefit your business. *
(recommended 200 words or less)
Your answer
Have you ALREADY applied for other forms of disaster funding (related to your current need)? *
If yes, to whom, how much, and what is the status?
Your answer
Do you PLAN ON applying for other forms of disaster funding (related to your current need)? *
If yes, to whom, how much, and when?
Your answer
If yes, please describe how a CISA loan would fit in among any other sources of disaster funding.
(recommended 100 words or less)
Your answer
Section 6: Loan Repayment
Requested length of loan *
Requested Beginning of Repayment Schedule *
Requested Repayment Schedule *
How do you plan to repay this loan, if farm profit is not sufficient? *
If repayment would come from off-farm income from household or family members, please document that in the financial documents listed in Section 7 (below).
Your answer
Business Reference 1 *
Business Name, Contact Person, Phone #
Your answer
Business Reference 2 *
Business Name, Contact Person, Phone #
Your answer
Business Reference 3 *
Business Name, Contact Person, Phone #
Your answer
Section 7. Other Requirements:
YOUR APPLICATION WILL BE REVIEWED ONLY AFTER THE FOLLOWING MATERIALS HAVE BEEN RECEIVED:
1. A copy of the most recent 1040 (including all Schedules) for the farm. (Or a 1065, if applicable.) *
If there were special circumstances during this year, or if you feel it would provide a better picture of your business, you may provide additional tax or financial documents from previous years.
2. A Farm Budget for the coming year. *
Must show all estimated income and expenses.
3. A current Balance Sheet OR a list of Assets & Liabilities *
4. A Monthly Cash Flow document (Optional)
Projecting 12 months into the future OR based on your Fiscal Year.
5. Profit & Loss Statement for last calendar year (Optional)
I certify that all information in this application and the accompanying materials is accurate and complete to the best of my knowledge.
Type your name below to confirm.
Your answer
EMAILS should be sent to:
office@buylocalfood.org
Subject Line: Emergency Farm Fund App

MAIL should be sent to:
CISA Emergency Farm Fund
1 Sugarloaf Street
South Deerfield, MA 01373

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