Name: Date:
Loan Proposal*
PERSONAL (for each owner/ co-signer):
Client Information Form*
Household Budget:* Include all income and expenses for the household.
Household Financial Statement:* Must be completed and signed.
Credit Research Authorization*
Resume: Personal history and work history (may be included in business plan.)
Copy of government issued photo ID (i.e. Driver’s License)
Personal Tax Returns: Last 2 years (fullreturns with schedules.)
BUSINESS (if business is operating):
Business Balance Sheet *
______Business Tax Returns: Provide full returns (with schedules) for the last 2 years.
Business Financial Statements: Provide balance sheets and income statements for the last 2year-ends and the most current interim statements.
LLC Agreement, Incorporation Documents, State registrations (if applicable.)
BUSINESS PLAN:
Budget for Financing*: List all funds required and all sources of funding.
Business Plan: The business plan at a minimum should answer the questions on Mercy Corps Northwest’sBusiness Plan Outline.
Profit & Loss and Cash Flow Budget Worksheet: Provide a month-by-month projection for the next 12 months. Please include a complete description of any key assumptions that influence financial projections.
LEASE:(if applicable)
Copy of existing or proposed business lease.
APPLICATION FEE:
$ 25.00 (cash, check, or money order)
* indicates blank forms provided
Total Capital Needed for Project:
Production Equipment$______
Vehicles$______
Store Fixtures$______
Office Equipment$______
Office Furnishings$______
Inventory$______
Materials$______
Operation Supplies$______
Office Supplies$______
Fees, Licenses and Fees$______
Advertising$______
Lease Deposits$______
Other Deposits$______
Insurance$______
Other
______$______
______$______
______$______
Total Capital Needs:$______
Source of Funds:
1. Mercy Corps NW Loan$______
2. Other Loans (please specify)
$______
$______
3. Owner’s Savings$______
4. Investors$______
5. Gifts$______
6. Other
______$______
______$______
Total Funding:$______
MERCY CORPS NORTHWEST
MERCY ENTERPRISE CORPORATION, CDFI
Credit Research Authorization
Name:(Last)(First)(Middle)
Address:Home Phone:
City:State:ZIP:
SSN#: Date of Birth:
Spouse’s Name: (Last) (First) (Middle) Spouse’s SSN#: Date of Birth:
Business Name:
Address:Business Phone:
City: State:ZIP:
When was the last time you reviewed your credit report?
(Note: You are legally entitled to one free copy of your credit report per bureau per year. See for more information.)
If you have checked your credit, what was your FICO score (from which bureau (s))?
Do you have any past-due accounts or accounts that have been sent to collections? If yes, please explain.
Are there any other issues with your credit report or credit history that you would like to share?
The undersigned hereby authorizes Mercy Enterprise Corporation or any of its affiliates, associates or assigns to make inquiries with Credit Bureaus and others it deems necessary to verify the accuracy of information provided to Mercy Enterprise Corporation in any form and to determine personal and business credit status.
(Signature)(Date)
(Spouse’s Signature)(Date)
Loan Program
Quick Reference Sheet
Loan Application:
Once all parts of the loan application have been submitted and are confirmed complete, the review process, including the loan committee meeting, takes 4-6 weeks, depending on when the documents were submitted, as the loan committee meetings are scheduled for the last Thursday of each month. There is a $25.00 application fee.
Legal Documents:
Once the loan is approved, the borrower will receive a signed copy of:
- Note5. Note Amendment (if the terms of the loan change)
- Loan Agreement6. Debt Subordination Agreement (when applicable)
- Security Agreement7. Borrowing Resolution (not for sole proprietorships)
- Loan Fee Invoice8. Continuing Guarantee (when applicable)
Loan Fees:
Fees vary depending on the loan.
Standard loan fees typically include: 1% of loan + $10 UCC Filing Fee + $55 Vehicle Title Fee.
Loan fees are collected prior to disbursing loan funds, and can be deducted from the loan or paid separately.
Loan Disbursals:
Loan money is always disbursed to a third party (vendor, seller, etc.) andis based on documentation (invoice, bill of sale, receipt, purchase order, etc.) Disbursals may take up to one week to complete; disbursals do not happen on Fridays.
Use of Loan Funds:
Use of the loan funds must be pre-approved by Mercy Corps Northwest staff.
Loans amounts vary between $500 and $50,000, with a 12% fixed interest rate, amortized up to 5 years.
Funds cannot be used for:
- Payment or Re-finance of Existing Debt
- Operating Deficits or Cash-Flow Problems
- Personal Income
- Emergency Situations
- Pre-Startup Research and Development
- Speculative Property (Real Estate, Stock, Collectibles)
- Non-accredited Trainings, Seminars, or Workshop Fees or Educational Materials
Important Dates:
Loan Fees Due:
- at signing. Loan fees can be deducted from the loan balance or paid separately.
Monthly Payments Begin:
- the first full month after loan fund disbursal (start-up businesses potentially have more time);
- payments are due the first day of each month for the duration of the amortization period.
Monthly Payments End:
- varies depending on the terms of the loan.
Monthly Income Statements to MCNW:
- the first day of the following month (to be submitted with the loan payment).
Annual Income Statement to MCNW:
- within thirty days after the end of the fiscal year for the business.
Payments:
Loan invoice are sent out each month before the end of the month. Payments are due on or before the 1stof each month. Monthly Profit & Loss statement are mailed out with the invoice, and should be returned with the payment. There is a $25 fee for returned checks.
Evaluation:
Since Mercy Corps Northwest receives funds from the State of Oregon, the City of Portland, and other sources that require us to collect and report on the economic indicators of the businesses, we ask our loan clients for monthly, quarterly, and annual profit & loss statements for the business. Client feedback is solicited at loan closing and six months after closing.
Useful Web Resources: - -
In Oregon, contact: Brian Fassett 503-896-5075or Rachel Stein503-896-5081
In Washington, contact: Anthony Gromko206-595-9496
revised 9/21/09