Reinvestment Fund - Initial Financing Request Form for a Clean Energy ProjectPage 1

Initial Financing Request Form

for aClean Energy Project

1. Contact Information for Person Completing this Application
Name: / Title:
Telephone: -- x / Cell Phone: -- / Email:
2. Information about the Applicant
Legal Name of Business/Organization: / Year Established:
Address: Street: / City: / State: / Zip:-
Purpose, Work or Services of Business/Organization:
Legal Structure (check one): Non-Profit Corp. For Profit Corp. Limited Partnership General Partnership
Limited Liability Company Sole Proprietorship Other:
3. Information about the Proposed Clean Energy Project
Project Name:
Project Address: Street: / City: / State: / Zip:-
Project Type(s): (check all that apply)
Solar PV Solar Thermal Wind Biomass Geothermal Combined Heat and Power
Demand Response Energy Storage Other:
Project Electric Generating Capacity: kW / Project Annual Electric Output: kWhs
Other Project Outputs(thermal energy or other useful byproducts):
Brief Project Description:
Project Dates: Estimated Project Start Date: / Estimated Project Completion Date:
Who will be purchasing/using the Project’s output?
What is status of the Power Purchase Agreement or other agreement for the Project’s output?
At what stage are the engineering/architectural plans for this project?
At what stage is the PJM interconnection analysis for this project?
4. Project Budget
Cost Category / Budget / Degree of Certainty about Cost
Real Property Acquisition / $
Project Soft Costs / Pre-development Costs / $
Project Hard Costs – Energy Measures / $
Project Hard Costs – Non-energy Measures / $
Other: / $
Total: / $
Important Comments about the Project Budget:
5. Energy Loan Request and Other Project Financing
Reinvestment Fund Energy Loan Request: / $
Other Potential Project Financing:
Amount: / Source / Status
Applicant Equity / $
Utility rebates / $
Public Grants / $
Other Loan / $
Other Loan / $
Other: / $
Project Total (including this loan request) / $
Important Comments about the Project Financing:

11/23/15

The Reinvestment Fund - Initial Financing Request Form for a Building Energy LoanPage 1

About the Initial Financing Request Form for a Clean Energy Project

This form is for an energy project that is primarily involves renewable energy generation or other distributed clean energy technologies. There is a separate Initial Financing Request Form for projects that primarily involve energy conservation and energy efficiency in buildings. That form can be downloaded from our website at

This form is not the full loan application form, but rather an abbreviated form to begin the discussion about yourclean energy project and possible financing by Reinvestment Fund. When this form has been completed and submitted, it will be reviewed by Reinvestment Fund staff, who will discuss your project with you and then decide if it appropriate to go to the next step of completing a full loan application package for your project.

Reinvestment Fund manages many different funds that support energy projects and this form will suffice for all of them. You do not need to decide which of Reinvestment Fund’s different energy loan programs is right for your project.

Directions for Completing and Submitting the Initial Financing Request Form

The Initial Financing Request Form for a Clean Energy Project is a Microsoft Word document. Simply type the requested information in the highlighted fields, check the appropriate boxes and save the document with a unique file name. The text fields will expand as you type, so do not feel that your answer is limited by the size of the text box. It is important that your answers provide all of the important details. Do not worry if the page breaks of the completed form do not match those of the blank form.

You may not know all of the information being requestedon the Initial Financing Request Form. That is usually the case and should not prevent you from submitting the form. Reinvestment Fund prefers to learn about your project early rather than at the end of the predevelopment phase.

Please submit your completed Initial Financing Request Formby email .

Or you may mail it to:Roger E. Clark

Reinvestment Fund

1700 Market Street - 19th Floor

Philadelphia, PA 19103

Questions

Questions about Reinvestment Fund’s financing for energy projects should be directed to Roger Clark at or 215.574.5814.

09/02/14