King of the South Capital™

1. APPLICANT INFORMATION

Legal Name

Date of Birth

Phone

Email for SBA Account

Home / Mailing Address

City / State / ZIP

2. BUSINESS / 1099 INFORMATION

Legal Business Name

DBA / Operating Name (if different)

Ownership %

Business Physical Address at Time of Disaster

City / State / ZIP

Type of Work / Industry

Date Business / Work Began

EIN (if applicable)

Active before disaster?

Yes No

3. DISASTER & ECONOMIC IMPACT

Disaster / Event

Disaster Dates

Parish / County & State

Impact Type

Economic injury Physical damage Both

Briefly explain how the disaster affected your ability to operate or earn income:

Normal Monthly Gross Income BEFORE Disaster

Lowest Monthly Gross Income AFTER Disaster

Current Monthly Gross Income

4. INITIAL DOCUMENT CHECK

Available for initial review: Government-issued photo ID 2025 Form 1040 2025 Schedule C

5. SECURE IDENTIFICATION NOTE & CERTIFICATION

Do not enter a Social Security number, SBA password, bank password, or other login credentials on this form.
Sensitive identity information, if required for the SBA process, should be collected separately through an appropriate secure method.

I certify that the information provided is true and complete to the best of my knowledge and authorize King of the South Capital™ to review information and documents I voluntarily provide for disaster-funding screening and document-preparation purposes. King of the South Capital™ is a private business, not SBA or another government agency, and does not guarantee approval or funding.

Typed Signature

Date

NEW CLIENT - SBA DISASTER INITIAL SCREENING