Form Center

2. Please review all program guidelines and complete the entire application prior to submittal.  

   As part of this application you will find Minnesota State Statute §13.591, which says that some data that is originally considered private will become public information if a loan is awarded.

6. Business Information
8. Legal Name of Business*

   Name should be the officially registered name of the business entity or a sole proprietorship not required to register with MN Secretary of State

10. Operating Name of Business
    If different from legal name
12. Briefly describe your type of business*
14. Business Street Address*
16. City*
    Only businesses in Hopkins, MN qualify for this program
17. State*
18. Zip Code*
20. Mailing Address

    If different from business address

22. City
23. State
24. Zip Code
26. Business Phone Number *
27. Email Address*
29. Business Website
33. Information of Individual Completing Application
35. First Name*
36. Last Name*
38. Title*
    Owner, CEO, Partner, etc...
40. Address*
42. City
43. State
44. Zip Code
46. Phone Number*
47. Email Address*
51. Is your business registered with the Minnesota Secretary of State?*

    1. Yes
    2. No
53. Do you own or lease the building where your business is located?*

    Applicants will need to provide a copy of a lease or statement of lease terms, mortgage statement, property tax statement or other documentation to show site control within the city.

    1. Own
    2. Lease
55. Business description (product, hours, customers, clients, number of locations, etc.), type (industry) and brief history of business:*
57. When did this business begin operating in Hopkins?*
59. Does the business operate (have a physical presence) in another city?*

    1. Yes
    2. No
61. If yes, please specify other location(s)
65. Redevelopment Impact
67. Was your business given a less than 120-day notice to vacate its current location?*

    1. Yes
    2. No
69. If known, is the notice to vacate due to a redevelopment project that has been approved by the City?*

    1. Yes
    2. No
    3. I don't know
71. Current operating status of business:*

    1. Open for business and/or operating online
    2. Open for business, but with reduced hours
    3. Reduced operations and/or operating online
    4. Completely closed
    5. Other
73. Please explain current status of business if none of the above apply.
75. Briefly explain how the business has been impacted by redevelopment.*
77. What are your plans for a new commercial space in Hopkins?*
79. Loan amount requested*
81. Please describe how you intend to use awarded loan funds to support your business. *

    Eligible expenses include costs that result in permanent building improvements. Please specify eligible expenses expected to be paid with funds. Include proposed expenses requested to be paid using total amount of loan.  

83. Is there anything else that we should be aware of in relation to your application or business?*
87. Supporting Documents

    The following documents must accompany an application for it to be deemed complete.

89. 1. Evidence that you have been given less than 120 day notice to vacate. *
91. 2. Evidence that you will own or lease a commercial space for your business in Hopkins. *

    Example documentation includes: Copy or statement of lease including terms, mortgage statement, property tax statement or other document to show proof of occupancy within City of Hopkins.  

    This could also include photograph or web map street image of the business location with evidence of business signage, if applicable.

93. 3. A W-9 Form (with signature).*
95. 4. Other supporting documentation deemed necessary by the City to assist in understanding the applicant’s situation.
99. Applicant Acknowledgements
101. 1. The Applicant shall hold City, its officers, consultants, attorneys, and agents harmless from any and all claims arising from or in connection with the Hopkins Business Retention Pilot Program or its Application, including but not limited to, any legal or actual violations of any State or Federal laws.
103. 2. The Applicant recognizes and agrees that the City retains absolute authority and discretion to decide whether or not to accept or deny any particular Loan Application, and that all expenditures, obligations, costs, fees, or liabilities incurred by the Applicant in connection with the Loan Application are incurred by the Applicant at its sole risk and expense.
105. 3. The Applicant acknowledges that it has read the Business Retention Pilot Program guidelines and understands that if the application is approved for funding, loan funds awarded must only be used to pay eligible expenses.
107. 4. The Applicant has reviewed a copy of Minnesota State Statute §13.591 as part of this application and understands that some information submitted will be considered public information if awarded a loan.
109. 5. Financial Assistance Certification: I hereby certify that the requested business loan is necessary due to direct and adverse effects related to redevelopment in Hopkins.
111. Tennessen Warning
     Data is being requested from you to determine if you are eligible for assistance from the City of Hopkins. You are not required to provide the requested information, but failure to do so may result in the City’s inability to determine your eligibility for assistance. The data you provide is classified as private or non-public and will not be shared without your permission except as specified in state and federal laws.
113. The undersigned, a duly authorized representative of the Applicant, hereby certifies the foregoing information is true, correct, and complete as of the date hereof; and agrees that:*

     • All disbursements from the loan will be used for eligible business expenses under the Business Retention Pilot Program;

     •Applicant will enter into a loan agreement prior to receiving a loan, and will file a report with the City within six months stating how awarded funds were spent;

     • Applicant shall be bound by all terms and provisions of the Business Retention Pilot Program.

     1. I agree.
115. Name/Title of Authorized Business Representative*
117. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
119. Electronic Signature*
Leave This Blank:


121. 1. Receive an email copy of this form.
122. Email address

     This field is not part of the form submission.

123. Submit Submit and Print

* indicates a required field