LOAN APPLICATION RUSSELL COUNTY MICRO-LOAN FUND

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1 LOAN APPLICATION RUSSELL COUNTY MICRO-LOAN FUND Name of Applicant Phone Name of Business Phone Federal Tax 1.0. Number Type of Business Date Established Number of employees Current Retained Creating BANK OF BUSINESS Name AccountType List all banks, types of accounts, and full addresses. Attach additional sheets if necessary. Project Budget (Use of Funds) MICRO-LOAN PERSONAL SOURCES TOTAL LOAN FUND INJECTION Land acquisition Construction/Expansion/ Repair Contingencies Specify: Machinery & Equip. Inventory Purchase Working Capital Acquisition of Existing Business Other: TOTAL PROJECT COST Term of loan years Years Interest Rate ---- % % *Attach sheet listing sources of other funds. Page 1 of 5

2 LIST OF COLLATERAL Cash Prepaid Expenses Land & Building Machinery & Equipment Furniture & Fixtures Accounts Receivable Inventory Other Specify Total Present Market Value Present Loan Balance Please provide an itemized list of all collateral, including legal description on real estate and make, model, and the serial number of all items. Attach information to support the values listed (appraisals, bills of sale, depreciation schedules). INDEBTEDNESS SUMNARY To whom payable. Name,. City, State, Zip Original amount borrowed Original date borrowed Present balance. Rate of interest. Payoff date Monthly payment, ~ Pledged security Current or past due? (If past due, enter amount owed) Page 2 of 5

3 STATEMENT OF OWNERSHIP Place an asterisk (*) beside each individual's name involved in day-to-day management (Attach separate sheets if necessary). % Of ownership Namej Namej Namej, Namej, Ch ckhst: To be considered complete, all the items listed on pages 4 and 5 of this application are required and must be submitted along with completed pages 1, 2, and 3. Additionally, page 5 must be signed and dated by the applicant. Page 3 of 5

4 CHECKLIST Information which must be supplied by the individual(s) seeking loan: Attachments 1. Formal letter of turndown from lending institution or letter from lending institution stating the amount willing to loan on this particular project. 2. Letters of commitment for personal injection and other source(s) of financing including availability of funds. 3. Business plan, (Small Business Development Center format is suggested) 4. Business financial statements (income and balance sheet) - three (3) years historical 5. Current (not less than 60 days) Financial Statement 6. Projected business financial statements - both income and balance for 3 years 7. Business and personal tax returns for 3 years 8. Aging of accounts receivable and payable (existing business) 9. Personal financial statement (owners of 20% or more and new investors) 10. Resume of management, including education, work experience, and management ability 11. Written history of business, including ownership type, parent or subsidiary relationships, location, product line, markets, and benefits company will derive from approval of loan 12. Itemization of project cost from page 1 of application form 13. Purchase agreement (executed) - may state "contingent upon purchaser receiving financing" 14. Letter of commitment for other sources of financing 15. Franchise agreement (if applicable) 16. Lease agreement (if applicable) 17. Construction projects over $5,000 require at least tvvo bids 18. Environmental questionnaire (provided with application form) 19. Current and projected employee listing 20. Authority to automatically debit business account for Micro-Loan payment (attach cancelled check or deposit slip). Page 4 of 5

5 Please answer the following questions and read the fohowing assurances: 1. Have you ever filed bankruptcy? Yes ; No If yes, please explain when, amount, and circumstances. 2. Does the business have any pending law suites)? Yes ; No 3. Are there any tax liens filed against you or the business? Yes ; No 4. Do you have any controlling interest in another business: Yes No If yes, will the existing/proposed business buy from or sell to this concern? Yes ; No, 5, I (we) do hereby agree to furnish current written evidence that I (we) cannot obtain private financing on terms and conditions that would permit completion and/or successful operation or accomplishment of the project activities to be financed. I (we) do hereby certify that the information contained in this application is true and correct. By signing below I authorize you to check my credit history and to answer questions others may ask you about my credit record. Applicant Print or Type Name Date Page 5 of 5

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