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Vernon County's Business Relief Loan Application

Vernon County’s Small Business Relief Loan is designed to help small local businesses meet immediate financial needs due to the COVID-19 outbreak in the United States and several executive orders from the Wisconsin Governor’s office.  These changes resulted in significant revenue losses for businesses in the County which makes paying immediate obligations difficult.   The purpose of this fund is to provide businesses small, deferred payment loans at 0% interest to pay for immediate needs such as rent/mortgage payments, utilities, accounts payable obligations, or working capital.

  • Eligibility:  All applicants must be a business located in Vernon County Wisconsin that have been operating long enough to demonstrate financial viability. Applicants must demonstrate to the Vernon County Economic Development Committee that they were directly and adversely affected by the COVID-19 related emergency.  
  • Funding Amount: Loans are up to $5,000 (minimum of $2,500)
  • Terms: Five year loan with a 6 month deferral option on payment at 0% interest.
  • Distribution: The Vernon County Economic Development Loan Committee will be making final funding determinations based on demonstrated business need. 
  • Application Deadline:  Applications will be accepted until 4:00 p.m. Tuesday, May 26, 2020.
  • Supporting Documentation:  2019 Business Taxes (or 2019 Profit and Loss Statement ONLY if taxes are unavailable)  AND  Articles of Incorporation.   (applications submitted without supporting documentation will be considered incomplete and ineligible.) 

  • Application Submittal:  Applications and supporting documentation can be submitted ONLINE through the APPLICATION FORM BELOW or you can  DOWNLOAD AND PRINT APPLICATION and send (with supporting documentation) to:                                                                                                                                                                                          Vernon County      Attn: Christina Dollhausen      318 Fairlane Drive, STE 94       Viroqua WI 54665 

  • Questions?  Please direct all questions related to this application to Christina Dollhausen at 608-606-6552, email at or Diane McGinnis at 608-637-5379, email at


Business Legal Name:


Primary Contact for Application

City or Town:

State or Province:

Zip or Postal Code:



Supporting Documentation
  • 2019 Business Taxes (or 2019 Profit and Loss Statement ONLY if taxes are unavailable)
  • Articles of Incorporation

Legal Structure

Business Description (include product/industry)

Month/Year Operations Began

Commercial Real Estate Value: $

Commercial Real Estate Debts: $

Business Equipment, Inventory, Misc Asset Value: $

Business Equipment, Inventory, Misc Debts: $

PROPOSED USE OF FUNDS  (Maximum $5000 - Minimum $2500)
Amount Requested ($2500 Min - $5000 Max.) $

Use: Rent/Mortgage $

Use: Utilities $

Use: Inventory $

Use: Insurance $

Use: Payroll Expenses $

Use: Other (Specify) $

Was your business forced to close due to the COVID-19 Pandemic?      Yes        No 

If YES, when did you close?

If you have been open, has your hours of operation been impacted?       Yes        No 

How much revenue has your business lost?       
Less than 10%  
10% to 24% 
25% to 50% 
More than 50%   

Briefly explain how COVID has impacted your daily operations and how have you responded (i.e. curbside pickup, extra clearning, technology costs, etc...)

Briefly describe plan for business to resume full operations once executive orders are lifted?

Number of Employees prior to COVID 19?
Have you had to lay off employees?    YES         NO 

If YES, how many?

Insurance Claims
Did you have applicable insurance?    YES               NO 

Other Funding
Have you received or applied for Paycheck Protection Program (PPP), Economic Injury Disaster Loan (EIDL) or any other federal, state or local loans or grants?    YES                   NO 

Please breifly describe your experience and amounts received, if any?

Please indicate the nature of any relationship (family or business) below that you have with the following people.   (Having a prior relationship with any of the persons listed does not disqualify you from participation in the loan program.)

Vernon County Economic Development Loan Staff

Rachel Hanson - County Treasurer
Ben Quackenbush - Legal Counsel
Diane McGinnis - Staff
Christina Dollhausen - Staff

Vernon County Board and Committee Members
Garrick Olerud
Gail Muller
Kyle Semke
Kay Stanek
Alycann Taylor
Tom Weston
Nancy Jaekal
Karen Dahl
Katie Helseth

Are any of the above family or business partners?  YES           NO 
If so, please indicate who and your (family or business) relationship.

The undersigned specifically acknowledge that:
Loan Agreements:

  • The property will not be used for any illegal or prohibited purpose or use;
  • All statements made in this application are made for the purpose of obtaining the loan herein;    Verification or re-verification of any information contained in the application may be made at any time by Vernon County or its agents, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by Vernon County, even if the loan is not awarded.
  • Vernon County, its agents, successors, and assigns will rely on the information contained in the application.  I have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I have represented herein should change.
  • The loan requested by this application will be secured by personnel guarantees and collateral may be required to obtain this loan;
  • In the event payments on the loan indicated in this application become delinquent, Vernon County, it agents, successors, an assign may, in additional to all their other rights and remedies, report my name and account information to a credit reporting agency.

Wisconsin Marital Property Act Credit Application
In order to comply with the provisions of the Wisconsin Marital Property Act, it is necessary to provide the following information:

1. Marital Status:       Married                      Unmarried                  Legally Separated 
2. If married:
Spouse's nameSpouse's address3. Notice to married applicants: No provision of a marital property agreement (including a Statutory Individual Property Agreement pursuant to s. 766.587, Wis. Stats.), a unilateral statement classifying income from separate property under s.766.59, or court decree under s.766.70 Wisconsin Statutes adversely affects the creditor unless the creditor is furnished a copy of the document prior to the credit transaction or has actual knowledge of its adverse provisions at the time the obligation is incurred.

If you wish to have a marital property agreement, unilateral statement or court decree considered in connection with your application, you may enclose a copy of it with this form.


I/WE CERTIFY that the information provided in this application is true and correct as of the date of my signature on this application.  I acknowledge my understanding that any intentional or negligent misrepresentation of the information in this application may result in civil liability and/or criminal prosecution.   
The parties acknowledge and agree that this loan application may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.
First and Last Name


Vernon County
Privacy & Disclosure Notice:    
We may collect non-public personal information about you from the following sources:

  • Information that you provide to us, such as on applications or other forms;
  • Information about your transaction with us or others; and
  • Information from others, such as credit bureaus, real estate appraisers and employers

We do not disclose any non-public personal information about you to anyone, except as permitted by law.
To maintain security of customer information, we restrict access to your personal and account information to persons who need to know that information to provide you products or services. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard your non-public personal information.
If you decide to close your account(s) or become an inactive customer, we will adhere to the privacy policies and practices as described in this notice.

Each of the undersigned by esignature hereby acknowledges the receipt of completed copies of the Privacy Notice.
First and Last NameDate

If you have completed your application and uploaded supporting documentation, you may