SOUTHEAST MISSISSIPPI COMMUNITY INVESTMENT CORPORATION LOAN APPLICATION

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1 SOUTHEAST MISSISSIPPI COMMUNITY INVESTMENT CORPORATION LOAN APPLICATION Sections I, II, III, and IV to be filled out by applicant. Application fee of $100 must be received before application can be processed. I. NAME AND HOME ADDRESS OF APPLICANT(S): II. INFORMATION ON BUSINESS TO BE ASSISTED: A. Name and Address: B. Telephone Number: C. Name of Principal Contact: D. Participating Bank: E. Loan Officer: F. Loan Officer s Telephone Number: G. Federal ID Number: III. PROJECT INFORMATION: A. Brief Project Description: 1

2 B. Total Cost of Project: $ C. Total Loan Amount Requested: $ D. Job Impact (Full Time Equivalent): Number Existing Number Created Total E. Projected Use of Funds: 1. Land Acquisition: $ 2. Land Improvements: $ 3. Purchase and/or Remodel: $ 4. New Construction: $ 5. Equipment: $ 6. Furniture & Fixtures: $ 7. Working Capital: $ 8. Contingencies: $ 9. Fees: $ 10. Inventory: $ Total Project Cost: $ 2

3 IV. REQUIRED ATTACHMENTS: A. Current personal financial statement. B. Company financial statements, balance sheets, and profit and loss statements for two years. For new businesses, please provide Federal Tax Returns for 2 years, if financial statements are not available. C. All applicants must include at least two year's projected profit and loss statements and cash flow statements. D. Credit Consent Form (attached). E. List of ownership if it s 20% or more, please include Social Security numbers and residency for the last two years. V. If you answer "Yes" to any of the following questions, please explain on an attached sheet. 1. Are there any outstanding judgments against you? 2. Have you been declared bankrupt within the past 7 years? 3. Have you had property foreclosed upon or given title or deed in lieu thereof in the past 7 years? 4. Are you a party to a lawsuit? 5. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? 6. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? 7. Are you obligated to pay alimony, child support, or separate maintenance? 8. Is any part of the down payment borrowed? 9. Are you a co-maker or endorser on a note? 3

4 ACKNOWLEDGEMENT: No assistance shall be provided to a small business that displays discrimination against any employee(s) because of race, religion, color, national origin, sex or age. The small business will agree to respond to all requests from the Southeast Mississippi Community Investment Corporation concerning servicing activities consisting of semiannual job request statements, semiannual and year end financial statements, copies of insurance declarations, and property tax receipts. CERTIFICATION/AUTHORIZATION: I hereby certify that, to the best of my knowledge, the information included in this application package for the purpose of obtaining a loan from the Southeast Mississippi Community Investment Corporation is true and correct. I hereby authorize SEMCIC to proceed with verification of my personal/company credit, the value of the security for this loan and other matters relating to this application. Signature Date Signature Date 4

5 CREDIT CONSENT FORM In preparation of all new loan applications through the Southeast Mississippi Community Investment Corporation, original files must include a credit report; this credit report must remain in the file for the life of the loan. Certain state or federal agencies or participating organizations may require the Southeast Mississippi Community Investment Corporation to submit loan participant's credit report within the application. Loan participant acknowledges and understands that the Southeast Mississippi Community Investment Corporation may avail this information to the required agencies within the loan applications. Signed this day of, 20. SS# Date of Birth SS# Date of Birth BY: (Signature) BY: (Signature) 5

6 JOB COMMITMENT CERTIFICATION do(es) hereby agree and certify that shall create new jobs at _ located in County, Mississippi, within twenty four months of a loan closing with the Southeast Mississippi Community Investment Corporation on. _further acknowledges that failure to do so without acceptable reasons shall give the Southeast Mississippi Community Investment Corporation the option of declaring the loan in default and demand payment in full. does further agree that shall respond semi~annually to the Southeast Mississippi Community Investment Corporation's request for information on the total number of employees, financial, insurance, etc. This the day of, 20. BY: (Signature) BY: (Signature) 6

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