Servco Pacific Vehicle Loan Program - Final Application

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Servco Pacific Vehicle Loan Program Application Organization and Program Profile Organization Name: ___________________________________________________________________ Administrative Office Address: _________________________________________________________ Select Island City: ______________________________ Island: ____________________ Zip Code: ___________

Service Location Address (if different from above): ________________________________________

Select Island City: ______________________________ Island: ____________________ Zip Code: ___________

EIN: _______________________ Number of Full-time staff: _________

Date of Incorporation: ___________________ Part-time staff: __________

Volunteers: __________

Operating Budget range: Select Range Vehicle you are interested in obtaining: Select Vehicle Mission Statement:

Please attach your current 2019 operating budget, showing your projected or secured annual sources of revenue, and projected annual expenses.


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