UNITED STATES VIRGIN ISLANDS
                    ECONOMIC DEVELOPMENT AUTHORITY
                                             Economic Development Bank 
Applicant Name: ________________________________________________
Name of Business:   _____________________________________________
Address of Business:   ___________________________________________
Telephone Numbers: (H) ___________________  (B) ___________________
Name
Physical Address
Telephone Number
________________________________                   __________________________________
Signature
                                   Date
E-mail Address:   _________________________________________________
PERSONAL  REFERENCE  FORM
Please list below four (4) Personal references (2 family members and 2 friends) along with a current
address and phone number for each reference. Please note that references listed must NOT reside with
applicant
Cell Phone Number:  ______________________________________________
SIGN