Clinch-Powell Rural Small Business Loan Fund Fact Sheet

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1 Clinch-Pwell Rural Small Business Lan Fund Fact Sheet Eligible Areas: Grainger, Claibrne, Hancck, Hawkins, Unin, Jeffersn, Greene, Ccke, Campbell and rural areas f Hamblen and Knx cunties in Tennessee. Lan Fund Purpse: T stimulate ecnmic develpment in rural East Tennessee. The lan fund will prvide affrdable financing t small businesses and entrepreneurs lcated in rural East TN areas meeting USDA RD definitins. Eligible Uses f Funds: Equipment, real prperty, cntracted materials (with sme limitatins). General perating funds, inventry and investments are nt eligible. Limitatins n sme agricultural purpses. Security: Lans require acceptable cllateral. Interest Rate: Belw market, based n credit scre, lan amunt, security Lan Limits: Up t 45,000 Lan Terms: Depends n lan purpse, amunt and cllateral. Hw t Apply fr a Lan: Submit a cmpleted lan applicatin and Basic Business Plan fr cnsideratin. Lan applicatin can be dwnladed frm Quick Links at Cntact: Fr mre infrmatin, cntact Lindy Turner, Clinch-Pwell RC&D Cuncil, Inc ,

2 Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Fund Applicatin Part I: Business Applicatin Sectin A: Business Infrmatin Is the cmpany registered t d business in the state f Tennessee? Yes N Legal structure f business: Sle Prprietr Partnership LLC Crpratin S-Crpratin Legal Name f Business: DBA Name (if any): Mailing Address: Cunty: City: State: Zip (+4): Physical Lcatin Address (if different): Business Phne: Business Fax: Business Website: Business TIN/ FEIN: Ave. Mnthly Sales: Ave. Annual Sales Last 3 YRS: Time in Business: Years Mnths Related Industry Experience: Years Mnths What are the prducts/services ffered by this business? Sectin B: Emplyee Infrmatin List the ethnicity, race, gender and natinality fr all emplyees (names nt required). D nt include 1099 subcntractrs. Emplyee Title Ethnicity Race Gender Natinality Ethnicity: Hispanic/Latin (L); r Nt Hispanic (H) Race: White (W); Black/African American (AA); American Indian/Alaska Native (NA); Asian (A); Native Hawaiian/Other Pacific Islander (OP) Gender: Male (M); Female (F) Natinality: Cuntry f citizenship r natinality (example, USA) Sectin C: Prpsed Cllateral Directins: List all ptential surces f cllateral. Prvide mdel numbers, serial numbers, ther ID numbers, the year it was acquired, purchase price and current estimated value. Only list items that yu wn utright. Yu must pssess the riginal title (in yur name) n all prpsed vehicles, trailers, etc. Applicatins with prpsed cllateral that meets r exceeds the lan request amunt are preferred. Item Year Acquired Make/Mdel VIN Number/Serial Number (D yu have the riginal title in yur name?) Purchase Price Current Estimated Value Where is cllateral stred?

3 Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Fund Applicatin Part II: Brrwer Applicatin Each persn with 20% r mre wnership f the business must cmplete a Brrwer Applicatin, Sectins I IV and sign and date. Sectin I: Applicant Infrmatin Percentage f Ownership: % D yu wn mre than 20% f any ther business? Yes N Last name: First name: Middle Initial: Residence mailing address: City: State: Zip (+4): Primary Telephne Number: Primary Address: Other Phne Number: Other Driver s License Number (r legal pht ID): State: Expiratin (mm/dd/yyyy): D yu rent r wn? (if yu live with smene else select rent) Rent Own Hw lng? Years Mnths Place f birth: (city, state r freign cuntry) Date f birth: (mm/dd/yyyy) Scial Security: Citizenship: If nt U.S., Type f VISA r alien registratin: Cash n hand in bank(s) Saving accunt(s) Sectin II: Persnal Financial Statement This persnal financial statement was cmpleted n (date): Hw much are yu requesting n this lan applicatin? (20,000 max.) Assets (Omit Cents) Liabilities (Omit Cents) Accunts Payable (including credit cards) Ntes Payable t Banks and Others: (Describe in Real Estate Owned belw) IRA r Other Retirement Accunt Secured: Accunts & Ntes Receivable Unsecured: Life Insurance (cash surrender value nly) Installment Accunt(s): Stcks and Bnds (describe belw) Real Estate (describe belw) Autmbile-Present Value (use Kelly Blue Bk Trade-in Fair Value) Persnal Prperty (describe belw) Other Assets (describe belw) Installment Accunt(s) Aut Mnthly payment: Installment Accunt(s) Other Mnthly payment: Mrtgage Debt n Real Estate (describe belw) Taxes Payable (describe belw) Other Liabilities (describe belw) Ttal Assets: Ttal Liabilities Ttal Assets - Ttal Liabilities = Net wrth

4 Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Fund Applicatin Describe any assets and/r liabilities here. Annual Surce f Incme Cntingent Liabilities Salary As Endrser r C-Maker Investment Incme Claims & Judgments Real Estate Incme Prvisin fr Federal Incme Tax Other Incme* Other Special Debt Ttal annual incme: Ttal cntingent liabilities: *Alimny r child supprt payments need nt be disclsed in Other Incme unless it is desired t have such payments cunted tward ttal incme. Describe annual surces f incme and/r cntingent liabilities in this space: Ntes Payable t Banks and Other (Use attachments if necessary. Each attachment must be identified as part f the statement and signed.) Name and Address f Ntehlder(s) Original Balance Current Balance Payment /mnth (week) Secured? Yes N Hw Secured r Endrsed Type f Cllateral Real Estate Owned (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part f this statement and signed.) Type f Prperty Primary Residence Prperty B Prperty C Physical Address Date Purchased Original Cst Present Market Value Mrtgage Balance Amunt f Payment per Mnth/Year Status f Mrtgage Sectin III: Mnitring Questins Are yu in default n a federal student lan r n any type f gvernment lan? Yes N D yu we back payments fr child supprt in any state? Yes N

5 Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Fund Applicatin Have yu ever been cnvicted f a felny? Yes N Are yu r any f yur cmpany s fficers, majr sharehlders r partners, r the spuses r clse relative f such individuals presently emplyed by the State f Tennessee? If s, please explain: Will any f the lan prceeds be used fr cnstructin, breaking grund, cnstructing a building, etc.? Yes N Yes N The fllwing infrmatin is requested by the federal gvernment fr certain types f lans, in rder t mnitr the lender s cmpliance with equal credit pprtunity. Yu are nt required t furnish this infrmatin, but are encuraged t d s. The law requires that a lender may neither discriminate n the basis f this infrmatin nr n whet her yu chse t furnish it. Hwever, if yu chse nt t furnish it, under federal regulatins, this lender is required t nte race/ethnicity n the basis f visual bservatin r surname. If yu d nt wish t furnish the infrmatin, please check the bx belw. Gender Male Female Ethnicity African American Asian-Pacific Islander Caucasian Hispanic/Latin Native American Refugee Highest Level f Educatin Cmpleted: Less than 9th Grade Sme High Schl Sme Cllege Cllege Graduate D yu have health insurance? Yes N Are yu physically disabled? Yes N Are yu a veteran f the United States Armed Frces? Yes N I d nt wish t furnish this infrmatin. High Schl Graduate/GED Federal Equal Credit Opprtunity Statement Federal law des nt allw discriminatin f any kind. Yu cannt be denied a lan because f yur race, clr, religin, natinal rigin, sex, marital status, handicap, r age (if yu can legally sign a cntract). Yu cannt be denied a lan because all r part f yur incme is frm a public assistance prgram. If yu believe that yu have been discriminated against fr any reasns, yu can write the secretary f Agriculture, Washingtn, D.C Yu cannt be denied a lan because yu exercised yur rights under the Cnsumer Credit Prtectin Act. Yu must have exercised these rights in gd faith. The Federal Agency respnsible fr seeing this law is beyed is the Federal Trade Cmmissin, Washingtn, D.C I hereby certify t the best f my knwledge that: Sectin IV: Certificate f Eligibility I am eligible t participate in the Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Prgram and sign belw as Principal and Guarantr, and I intend t establish r expand a small business enterprise in a rural area f Tennessee. and My business has fewer than 10 emplyees including the wners, and I have established that I have financial need, am financially sund and capable f repaying the mnies I brrw under this lan prgram, and I have cmpleted a business plan and small business training frm a Tennessee Small Business Develpment Center r ther apprved training prvider, and

6 Clinch-Pwell RC&D Cuncil, Inc. Rural Small Business Lan Fund Applicatin I agree t have my applicatin reviewed by representative(s) frm participating lenders including bank and USDA, and I authrize RC&D t utilize credit bureau/reprting agencies and/r its wn agents fr purpses f verifying the accuracy f any infrmatin prvided by brrwer and fr purpses f assessing and mnitring brrwer credit status, and If the lan is awarded, all prceeds will be used strictly fr business purpses, and If the lan is awarded, the cmpany cncurs understanding f the USDA and State f Tennessee s Cmptrller ffice s pprtunity t audit prgram spending, and As a recipient f federal funds, I agree that my business will cmply with Title VI regulatins, and This applicatin may nly be mdified as apprved in writing by the lan manager. N ther representative f RC&D r ther agency is authrized t make any verbal r written mdificatin t this applicatin, and All the infrmatin prvided herein is true and accurate. Applicant signature: Print name: Date: CONSENT TO RELEASE & VERIFY INFORMATION As a participant in the Clinch-Pwell Rural Business Lan Prgram, I authrize Clinch-Pwell RC&D Cuncil, Inc. t use my Scial Security number fr the purpse f btaining my credit reprt fr the purpse f evaluating my credit histry. I als authrize the release f my credit reprt t Clinch-Pwell RC&D Cuncil, Inc. by thse credit reprting agencies frm which Clinch-Pwell RC&D Cuncil, Inc. may request my credit reprt. I understand that the infrmatin n my credit reprt will be used by Clinch-Pwell RC&D Cuncil, Inc., its affiliates, lenders, USDA Rural Develpment, nly fr the purpse f determining my qualificatin fr a business lan and my eligibility fr assistance. This infrmatin will nt be disclsed t any ther third parties withut my cnsent. Applicant signature: Print name: Date: 7995 Rutledge Pk Rutledge, TN ph: f: Clinch-Pwell RC&D Cuncil, Inc. is a 501C3 nt-fr-prfit rganizatin and an equal pprtunity emplyer and prvide. All prgrams and assistance f the RC&D Cuncil are available withut regard t race, clr, natinal rigin, gender, religin, age, disability, plitical beliefs, sexual rientatin, and marital r family status.

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