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.