Application Form for CISA Emergency Farm Fund
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Section 1:  Applicant Information
Name(s) of Owner(s): *
Street address *
City *
State *
Zip code *
Phone number *
Email address(es) *
Section 2:  Business Information
Farm name *
Business street address
(if different from applicant mailing address)
Business city
Business state
Business zip
Business phone
Business email
Business website(s)
Type of business: *
Legal Name of Borrower(s) *
(This could be your farm business or you as an individual.)
Section 3: Business overview
Please provide a basic description of your business, including a brief history, ownership and management, products, and markets. *
(recommended 300 words or less)
What were your gross annual sales in 2020? *
Are you a limited resource farmer?
Check yes if, for both 2017 and 2018, your gross farm sales were no more than $180,300 AND your total household income was less than $31,288 for Franklin County, $28,004 for Hampden County, or $36,605 for Hampshire County.)
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Section 4:  Description of damage to business as a result of 2021 excess precipitation
Please describe what losses you’ve experienced and/or are expecting because of the extreme weather. *
(recommended 200 words or less)
What is the estimated monetary loss? *
Section 5: How would you use the loan?
Loan amount requested $ (max $20,000) *
Must be less than or equal to the amount in the previous question (Section 4).
Please provide a brief description of how the funds would be utilized and how this would benefit your business. *
(recommended 200 words or less)
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 of the application?
Do you plan applying for other forms of disaster funding (related to your current need)? *
If yes, to whom, how much, and when?
If yes, please describe how an Emergency Farm Fund loan would fit in among other sources of disaster funding.
(recommended 100 words or less)
Section 6: Loan Repayment
Loan repayment begins 6 months following the date of the loan and continues in monthly installments until the loan is fully repaid in three years. You may choose to pay the loan back early. We are willing to consider some changes to this schedule on request (for example, beginning repayment later than 6 months or seasonal payments to match business cash flow). If you would like a different repayment schedule, please explain here.
What options do you have to repay this loan, if farm income 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).
Business References
Please provide us with the names and contact information for three people who can serve as business references. These can include businesses from whom you buy products or services for your business, or regular business customers (e.g. a retailer who buys from you regularly).
Business reference 1 *
Business Name, Contact Person, Phone #
Business reference 2 *
Business Name, Contact Person, Phone #
Business reference 3 *
Business Name, Contact Person, Phone #
Section 7. Other Requirements:
YOUR APPLICATION WILL BE REVIEWED ONLY AFTER THE FOLLOWING MATERIALS HAVE BEEN RECEIVED. If you need help understanding or assembling what is required, please contact Stephen at CISA (stephen@buylocalfood.org and/or 413-665-7100, ext. 17).

We prefer to receive documents electronically but can also accept them via regular mail. Once we receive your application, you will be sent a link where you can upload your documents.

Required for all loans:
1. A copy of the 2021 1040 (including all Schedules) for the farm. (Or a 1065, if applicable.) If 2021 taxes are not yet completed, please send 2020 tax forms and management’s Profit and Loss statement for 2020. *
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. For example, a profit and loss statement or monthly cash flow projection for the upcoming year can be very useful, if available. If you suggested above that off-farm income might be used to repay this loan, please provide a copy of your most recent personal or household tax return.
2. A farm budget for the coming year. *
Completed to the best of your ability using current knowledge and showing estimated income and expenses.
3. A current Balance Sheet or a list of Assets & Liabilities *
Additional requirement for loans above $5000: Tax documentation
Larger loans require an additional year of tax documentation. Please send both 2020 and 2021 tax returns.  If 2021 taxes are not yet completed, please send 2019 and 2020 tax returns and management’s Profit and Loss Statements for 2020.
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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.
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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