Loan Application

Loan Application

This loan application is designed to provide Finance Fund with necessary information to evaluate your loan request. Please indicate N/A in fields that do not apply to your project.

Date of Application:
Applicant Information
Applicant/Company Name: (Full Legal Name)
Street Address:
City: / State: / Zip:
County:
Phone: / Fax:
Mailing Address: (if different than street address)
City: / State: / Zip:
Website:
Contact Information
Contact Person: / Title:
Contact Phone: / Contact Email:
Executive Director:
Executive Director Email:
Company Profile
Structure of Business: (Check One) / C-Corporation LLC or LLP
S Corporation Partnership
Sole Proprietorship Other
Fed Tax ID/EIN #:
NAICS:
Month/Year Business was Established:
Company Bank Reference
Name of Primary Bank:
Bank Address, City & State:
Bank Officer:
Bank Account Number: / Checking Savings
Bank Routing Number:
Ownership of Applicant Company
Name / Percentage Owned / Personal Guarantor
Yes No
Yes No
Yes No
Guarantor Information (if applicable – all individuals with >20% ownership)
Name: / Name:
Address (with City, State and Zip): / Address (with City, State and Zip):
Contact: / Contact:
Phone: / Phone:
Fax: / Fax:
Email: / Email:
% of Ownership: / % of Ownership:
Personal Net Worth: / Personal Net Worth:
Key Management (Attach resumes or biographies as Exhibit A)
Name / Title / Yrs. with Co.

THE PROJECT

Amount of Loan Request
Loan Category Use (Check all that apply):
Machinery & Equipment
Information/Technology System
R/E Acquisition
R/E Renovation/Addition
Inventory
Working Capital
Other / $
$
$
$
$
$
$

Please provide background information and the experience of the key individuals responsible for implementing the project (See Required Attachments):

Project Description Please provide an Executive Summary that describes the Project—purpose, goals, objectives, and advantages. If this is a collaborative effort, please elaborate.
Project Information
Project Name:
Project Address or Parcel ID Number:
Project City: / State: / Zip (+4):
Project County:
Project Community:
Project Census Tract Number(s):
Census Tract Info available at: http://www.cdfifundhelp.gov/index.asp?section=NMTC
Community Type: / Major Urban Area (total urban/suburban population >1 million
Minor Urban Area (total urban/suburban population <1 million
Non-Metropolitan Area (census tract located outside of an MSA)
Community Type Info available at: http://www.census.gov/2010census/
Timeline of Construction Project:
Anticipated impact on your services and cash flows (revenues and expenses)
Project Tax ID Number:
Project Information – Equipment Purchase (if applicable)
Equipment Description (detailed):
Equipment Purchase: / Before closing of the loan After closing of the loan
Site Control Information (check one)
Own Options Lease/Rent Not Controlled In Contract
Please explain lease/rent terms, options, or purchase contract:
Are there any liens or claims on the property: / Yes No
If yes, please explain:
Mortgage Holder Information (if applicable)
Mortgage Holder Name:
Address:
City: / State: / Zip:
Contact Person:
Phone: / Fax:
Email:
Mortgage Balance: / Origination Date:
Project Sources of Funds
Source (1) / Amount / Type (2) / Status (3)
$
$
$
$
$
$
$
$
Total Sources / 0 / Note: Right click on “0” to left and select Update Field to add (autosum) source amounts in table.
(1)  Name of Source
(2)  Debt, Cash, Grant, Owner’s Equity, Tax Credit Equity, In-kind, Other
(3)  Committed (legally binding commitment from source); Term Sheet (source is not legally bound); Application Pending (submitted but not yet decided); Disbursed; Other: Please explain
Project Uses of Funds
Use (1) / Amount / Who will perform the activity?
$
$
$
$
$
$
$
$
Total Uses / 0 / Note: Right click on “0” to left and select Update Field to add (autosum) use of funds amounts in table.
(1)  Bldg. or Land Acquisition; Bldg. Renovations; Leasehold Improvements; Machinery and Equipment; Construction Hard Costs; Construction Soft Costs; Closing Costs, Working Capital
Project’s Geographic/Demographic Information
Please select one: Ohio Indiana Kentucky
House District #:
Senate District #:
US Congress District #:
Local Government:

FINANCIAL INFORMATION

Financial Summary Please provide the financial information requested in the “Required Attachments” section below. In addition, please comment on any significant changes in revenue makeup, expenses or balance sheet items from Year to Year, or variations from Budget, such as:
Income Statement
Changes in Revenues / Explanation of Item
Item:
Item:
Item:
Increases or Decreases in Expenses / Explanation of Item
Item:
Item:
Item:
If you have had any losses during the last 3 years, please briefly discuss any contributing factors:
Debt Schedule
Please list all the sources of debt below:
Lender / Amount Outstanding / Maturity Date / Monthly Payment / Purpose
Please discuss notable increases in fixed assets:
Item / Purpose / Value / How Financed
Please provide details on Accounts Receivable:
Total A/R as of most recent fiscal quarter / Date / % Aged Less than 30 days / % Aged 31-60 Days / % Ages 61-90 Days / % Aged Over 90 Days
Has your accounts receivable quality remained consistent? Please briefly discuss reasons for any change in quality:
Please use this space to comment on other variations or elements of your financial statements that may require clarification:
Equal Credit Opportunity Act

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, creed, color, religion, national origin, sex, sexual orientation, age, disability, or any political or union affiliation because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administrates compliance with this law concerning this creditor is The Federal Trade Commission (FTC). Visit www.ftc.gov for more information.

Certification Statement

I/We agree to all of the terms and conditions applicable to the request and authorize Finance Fund to investigate my/our personal and business financial credit history as necessary to process a loan application. Each of the undersigned authorize any person or consumer reporting agency to give you any information it may have on the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned and authorize you to release information if the request is approved, to consumer and business reporting agencies and others whom we believe have a legitimate need for the information. The undersigned, in applying for financial assistance from Finance Fund, recognizes that prior to receiving any financial assistance they agree to comply with all federal, state and local laws and regulations to the extent that such are applicable.

The foregoing and any supplementary information are warranted by the undersigned to be true, accurate, and not misleading as of the date submitted and are furnished to induce you to make the loan applied for, which, if granted, the proceeds thereof will be used only for the purpose stated above. The undersigned knows that you rely and continue to rely theron until written notice of any change therein is received by you. The undersigned will give you immediate written notice of any material changes in the undersigned’s financial condition, including any lawsuit, begun or threatened, the effect of which may be to materially alter the said condition.

Agreements and Representations:

1.  You represent to Finance Fund that you are authorized to sign this application on behalf of the applicant, and that you have the title indicated below, and that no other person(s) is/are required to sign this application in order to bind the applicant or to make any of the representations, agreements, or other information in this application accurate, effective, and legally binding.

Business Name:
Authorized Signature: / Date:
Printed Name: / Title:
Authorized Signature: / Date:
Printed Name: / Title:
Guarantors/Co-Signers

Guarantors/Co-Signers must personally sign this application. If there are more signatures required than signature lines available, please print this signature page for the required number of signatures and include it with this application.

Signature: / Signature:
Print Name: / Print Name:
Date: / Date:
Required Attachments The following list of required attachments is considered part of the loan application. Each of the exhibits must be tabbed and attached to the back of the loan application.
Exhibit A: / Business Plan and History of Business
Exhibit B: / Business Financial Statement (within 60 days)
Exhibit C: / Business Federal Income Tax Returns (previous 3 years)
Exhibit D: / Personal Federal Income Tax Returns of all owners with 20% or more ownership interest
Exhibit E: / Projected Monthly Cash Flow Statement (first year)
Exhibit F: / Projected Annual Cash Flow Statement (second and third years)
Exhibit G: / Projected Income/Expense Statement (P&L Statement)
Exhibit H: / Personal Financial Statements (within 60 days)
Exhibit I: / Sales Contract(s) and Bids (when applicable)
Exhibit J: / Organizational Documents (Articles of Incorporation, By-Laws, Certificate of Good Standing)
Exhibit K: / List of Board of Directors with the following information for each member: member name, principal employer, occupation, address, term, Board position, gender, race/ethnicity. (Required for Nonprofits Only)
Exhibit L: / Resolution to Borrow with Two (2) Board Signatures (Required for Nonprofits Only)
Exhibit M: / Resumes of Senior Management and Individual(s) responsible for implementing the project. (Executive Director, CFO or equivalent, Project Manager, etc.)
Exhibit N: / Other Documentation Important to the Application (i.e. old appraisals, old environmental reports, etc.)
Submittal of Application

Application can be mailed to: Finance Fund, 175 South Third Street, Suite 1200, Columbus, Ohio 43215; sent by fax to: (614) 221-7493 or emailed to Tara Campbell, Vice President of Lending at with a copy to: Ginny Edgington, Associate Manager of Programs at .

Questions concerning this application should be directed to Tara Campbell at (614) 568-5047 or via email at .

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