microsoft word - saco celf loan app14e8b741-214c-42e2-be74... · web viewof fixed assets for the...

EDA funded Economic RecoveryRevolving Loan Fund

Southern Maine Planning and Development Commission Full Application

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All relevant information must be received by staff before loan review will start. Please (X) if attached or (N/A) if not applicable:

1) Financing Application

2) Historical Financial Statements: Last three (3) years Business and personal tax returns

3) Interim Financial Statements: No more than 90 days prior to application

4) Debt Schedule: Attached Exhibit

5) Personal Financial Statement: For any owner with 20% or Greater interest in business

6) Supporting information as necessary: Special Licenses / estimates / quotations /receipts / contracts / orders / invoices / sales agreements or documentation from architects, engineers, contractors, suppliers or others involved in the sale, lease, construction or renovationof fixed assets for the applicants project, including schedules of implementation / Security / Collateral Description: include most recent appraisal of real estate, machinery and equipment when applicable/ Debt Schedule / Aging of Accounts Payable & Accounts Receivable / Letters of Commitment from bank / agency / Copy of Lease / Deed.

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Project Applicant Date of Application

A. Borrower's Name Cell Phone Number

Social Security Number

Name of Business Phone Number

Address Federal Tax ID Number

Address 2 DUNS Number(https:// www.dandb.com/ )

City, State, Zip Code Contact Person

Amount Requested E-Mail Address

Website NAICS #(https:// www.naics.com/ )

B. Business Organization:

S Corporation C Corporation Partnership Sole Proprietorship

Limited Liability Corporation _ _

If Incorporated, list Date and State of Incorporation:

Years in Business:

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Please answer all questions thoroughly and completely to the best of your ability. Missing information will onlydelay the processing of your application. Only when a completed application and all materials referred to on the checklist are received will loan processing begin.


C) Ownership / Management:1) Major Stockholders, Partner or Proprietors with 20% or greater interest:

Name: Address: Ownership %: Date of Birth: Social Security #:

2) Project Representatives:

Contact Name: Phone Number:

Regular Bank:

Probable Lender:

Legal Representative:

Accountant:

3) Disclosure Information:

a) Has any individual above or your company received any government assistance (i.e., direct loans, guaranteed loans, grants) from Federal State or Local sources (SBA, USDA, EDA, CDBG, HUD, FAME etc.), including but not limited to any loans which were guaranteed by these sources? This includes any assistance which you personally guaranteed or in which you had any ownership in the borrower.

YES: NO: If YES, please explain:

b) Has any individual or company associated with any individual above, been involved with bankruptcy proceedings, insolvency, bank "work-out" forced or friendly liquidation and the disposition of those activities?

YES: NO: If YES, please explain, listing parties involved:

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c) Has the company or any stockholder with 20% or greater investment in the company been convicted of any crime or had any judgment filed against them, currently or pending?

YES: NO: If YES, please explain, giving details regarding results, judgments, or penalties:

d) Does the company or any individual above have delinquent tax authority obligations (IRS, State Sales, Real Estate, Property, etc.) or liens or judgments that were the result of any of these or previous tax authority obligations?

YES: NO: If YES, please explain:

4) Project Summary

a) Brief Description of Business and History:

b) Explain the impacts to your business due to the pandemic, and how the funds from this loan will aid in recovering some of these losses:

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c) Sources and Uses of Financing:

i. Source of Funds:Name: Amount: Term: Rate:

Private:

Other Public:

Other Source:

Other Source:

Equity:

Total

ii. Use of Proceeds:Description: Amount:

Working Capital:

Equipment Acquisition:

Equipment Installation:

Repairs/Renovations:

Other Construction Costs

Miscellaneous:

Professional Fees:

Other (Specify):

Total:

d) Employment:

i. Number of Employees:

Current: full-time: part-time:

Number of jobs to be created: full-time: part-time:

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ii. Current Annual Payroll: $

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e) Confidentiality of Records:

I (we) request that information provided by me (us) and developed by the lending agency, or its staff or agents, with respect to this application for financial assistance be designated Confidential and not open for public inspection. This includes the disclosure of tax or financial information; assessment of the creditworthiness or financial condition; records obtained by the lending agency in connection with the monitoring or servicing of an existing project; proprietary information; and information regarding investors, current and potential.

f) Certifications:

To the best of my (our) knowledge, the above information is accurate, true, and correct. I (We) understand that any false or misleading information I (we) provide may lead to my (our) disqualification from this program. I (we) authorize the lending agency and others on its' behalf to gather, collect and verify any and all information about me (us) furnished in connection with this application or which it believes is advisable and which relates to this application and loan. The information that may be verified includes, but is not limited to, the following: employment, pensions, mortgages, deposits, and any other income; personal or business loans; hazard insurance; and further, to obtain a credit report. If this application is approved, I (we) will be obligated by the promissory note I (we) will sign and the lending agency will send me (us). This application remains the lending agency's property, whether or not this application is approved.

Applicant's Signature Co-Applicant's Signature

Applicant's Name / Title Co-Applicant's Name / Title

Date Date

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DEBT SCHEDULEBusiness obligations only, not personal loans

As of , 20

(As of the date of most the recent financial statement)

Original Date

Original Amount

Monthly Payment

Interest Rate

Present Balance

Maturity Date Creditor Collateral Up to

Date?

Show estimates for new loans expected during the next 12 months

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of 10 Revised: 04/20


PERSONAL FINANCIAL STATEMENTIMPORTANT: Read these directions before completing this statement.

If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections 1 and 3.If you are applying for joint credit with another person, complete all Sections providing information in Section 2 about the joint applicant.If you are applying for individual credit, but are relying on income from alimony, child support, or on the income or assets of another person as a basis for repayment of the credit requested, complete all Sections, providing information in Section 2 about the person whose alimony, support, or maintenance payments or income or assets you are relying on.If this statement relates to your guaranty of the indebtedness of other person(s), firm(s) or corporation(s), complete Sections 1 and 3.

SECTION 1 – INDIVIDUAL INFORMATION SECTION 2 – OTHER PARTY INFORMATIONName NameResidence Address Residence AddressCity, State & Zip City, State & ZipPosition or Occupation Position or OccupationBusiness Name Business NameBusiness Address Business AddressCity, State & Zip City, State & ZipRes. Phone Bus. Phone Res. Phone Bus. PhoneE – Mail E – MailSECTION 3 – STATEMENT OF PERSONAL FINANCIAL CONDITION AS OF , 201

PERSONAL ASSETS In Dollars PERSONAL LIABILITIES In Dollars(Do not include Assets of doubtful value) (Omit cents) (Omit cents)

Cash on hand and in this bank $ Notes Payable to banks – secured – See Sch. F $Cash in other banks Notes Payable to banks – unsecured – See Sch. FU.S. Govt. & Marketable Securities – See Sch. A Due to brokers

Amounts payable to others – securedNon-Marketable Securities – See Schedule B Amounts payable to others – unsecuredSecurities held by broker in margin accounts Accounts and bills dueRestricted or control stocks Unpaid income taxPartial interest in Real Estate Equities – Other unpaid taxes and interest

See Schedule C Real estate mortgages payable – See Schedule DReal Estate Owned – See Schedule D Other debts – itemizeLoans ReceivableAutomobiles and other personal propertyCash Value – Life Insurance – See Schedule EOther assets – itemize – See Sch. G, if applicable

TOTAL LIABILITIESNET WORTH

TOTAL ASSETS $ TOTAL LIABILITIES AND NET WORTH $SOURCES OF INCOME FOR YEAR ENDED: 201 PERSONAL INFORMATION (Attach separate sheet if necessary)Salary bonuses & commissions $ Do you have a will? If so, name of executor:DividendsReal estate income Are you a partner or officer in other venture(s)? If so, complete Sch. GOther income (Alimony, child support or separate

maintenance income need not be revealed if you Are you obligated to pay alimony, child support or separatewish not to have it considered as a basis for maintenance payments? If so, describe:repaying this obligation.)

Are any assets pledged other than as described on schedules? If so,describe:

TOTAL $CONTINGENT LIABILITIES Income tax settled through (date)

Do you have any contingent liabilities? If so, describe: Income tax settled through (year):Are you a defendant in any suits or legal actions? If so, describe.

As endorser, co-maker or guarantor? $On leases or contracts? $ Personal bank accounts carried at:Legal claims $Other special debt $ Have you ever been declared bankrupt? If so, describe:Amount of contested income tax liens $



SCHEDULE A – U. S. GOVERNMENT & MARKETABLE SECURITIESNumber of Shares or Face Value (Bonds) Description In Name Of Are These Pledged? Market Value

SCHEDULE B – NON-MARKETABLE SECURITIESNo. of Shares Description In Name Of Pledged? Y/N Source of Value Value

SCHEDULE C – PARTIAL INTERESTS IN REAL ESTATE EQUITIES (Attach separate sheet if necessary)

Address & Type of Property Title In Name OfOwner- ship %

Date Acquired Cost

Market Value

Monthly Payment

R. E. Taxes

Mortgage Balance

SCHEDULE D – REAL ESTATE OWNED (Attach separate sheet if necessary)

Address & Type of Property Title In Name OfDate

Acquired CostMarket Value

Monthly Payment

R. E. Taxes

Mortgage Balance

SCHEDULE E – LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCEName of Insurance

Company Owner of Policy BeneficiaryFace

Amount Policy LoansCash Value

SCHEDULE F – BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED

Name & Address of Lender Credit In The Name OfOriginal

DateHigh

CreditCurrent Balance

Secured or Unsecured

Monthly Payment

SCHEDULE G – BUSINESS VENTURESName & Address

Of Business VentureTotal Assets

Listed In Section 3Ownership Percentage

Position/Title in the Business

Total Assets Of Business Line of Business

Years In Business



The information contained in this statement is provided for the purpose of obtaining or maintaining credit with you on behalf of the undersigned, or persons, firms or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in your favor. Each undersigned understands you are relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that you may consider this statement as continuing to be true and correct until a written notice of a change is given to you by the undersigned. You are authorized to make all inquiries you deem necessary to verify the accuracy of the statements made herein and to determine my/our credit worthiness. You are authorized to answer questions about your credit experience with me/us.

Signature (Individual) _ Date Signed

S. S. No. Date of Birth

Signature (Other Party) Date Signed

S. S. No. Date of Birth

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