L O A N A P P L I C A T I O N P a g e 1 1. General Information Borrower Entity Name: City: State: Zip: Borrower Entity Type Corporation S-Corporation Partnership Proprietorship LLC or LLP Nonprofit Organization Other State of Incorporation or Partnership: FEIN #: Date of Incorporation or Partnership: Year Established: NAICS Code (if known): Principal Product or Service: Is the Borrower/Operating Company licensed in Philadelphia? No Yes Type of Business Ownership: MBE DBE WBE Veteran-Owned N/A If yes to the above, is your business certified? No Yes If MBE, please state the Race/Ethnicity of Ownership Majority: 2. Borrower Contact Information Main Contact: Phone #: Email: Borrower Entity Principals Age SS# Owner % 1. Name & Title: 2. Name & Title: 3. Name & Title: If operating business information, ownership, and location are different from above, please provide the same information on a separate sheet. Also list all Subsidiaries and Affiliates of Borrower and Operating Company.
L O A N A P P L I C A T I O N P a g e 2 Please provide contact information for the following (if available): Accountant Name Company Name Phone Email Attorney Bank 3. Credit and Financial History 1) Have you ever filed for bankruptcy? 2) Has the business ever filed for bankruptcy? 3) Do you have any accounts in collection, judgments or unpaid taxes filed against you personally? 4) Have any Federal or State tax liens been filed against your business within the past 10 years? 5) Have you been personally sued within the past 10 years or are you currently being sued? 6) Has your business been sued within the past 10 years or is it currently being sued? 7) Have you or your business defaulted on any loans? 8) Have you ever been convicted, charged or indicted for a felony? 9) Have you or your company been debarred from doing business with the city of Philadelphia, state or federal government? No Yes 4. Business and Project Narrative Please attach up to 3 pages giving a narrative description of your business and the proposed use of requested funds from PIDC. Narrative should include a description of products and services, description of your market, major customers, major competitors and suppliers, and principal challenges presently facing the business. The proposed use of PIDC funds should clearly define the entire project scope and other required financing to complete the project as well as how this project will benefit the company when fully completed.
L O A N A P P L I C A T I O N P a g e 3 5. Project Budget Please attach term sheets or commitment letters for additional sources of funding, if available. If other, please let us know what the source/use is in the blank space provided. Sources Uses Requested Loan $ Purchase Building and/or Land* Amount from PIDC $ Equity $ Machinery & Equipment Capital $ Bank Loan $ Leasehold Improvements $ Other: $ Working Capital $ Other: $ Refinance of Existing Debt $ Purchase Business $ Soft Costs (Professional Fees, Loan Commitment Fees, etc.) $ Other: $ Total $ Total *For Purchase Building and/or Land Address of Property: Total Building Square Feet Sq. Ft.: Square Feet to Be Occupied by Borrower at Closing If a building purchase, will this replace the company s current locations? Sq. Ft.: Yes No
L O A N A P P L I C A T I O N P a g e 4 6. Proposed Collateral PIDC loans require collateral, which may include the following: Commercial Real Estate owned by Borrower and Subsidiaries/Affiliates Residential and/or Investment Real Estate Business Assets including Machinery and Equipment, Accounts Receivable, Inventory, etc. Personal Guarantees of Principals Company Guarantees of Operating Company and Subsidiaries/Affiliates Liquid Assets such as Securities, Certificates of Deposit, and Cash Surrender Value of Life Insurance Policies Please describe any assets which would be available to secure the PIDC financing below. 7. Employment Current # of Employees Jobs Created (Projected New Employees over next 3 years) Full-Time Part-Time Independent Contactors 8. Additional Information How did you hear about PIDC? Please let us know in the space provided. It is customary for PIDC lending staff to require additional information or documentation during the loan review process. Commonly requested materials include, but are not limited to: Aging of Accounts Receivable and Accounts Payable Agreement of Sale for Real Estate Purchase or Copy of Lease Appraisals for Real Estate Being Acquired or Offered as Collateral Phase I Environmental Study or Acceptable Environmental Screening Report
L O A N A P P L I C A T I O N P a g e 5 Construction Quotes for New Construction or Renovations Supplier Quotes for New Machinery and Equipment Purchases Pro forma income statement projections for three (3) years following Project completion 9. Certification, Authorization, Signature The undersigned (the "Applicant") hereby certifies that the information contained in this application and the attachments thereto (the "Application Submissions") is complete, true and correct. The Applicant hereby agrees to notify PIDC promptly of any material changes to the Application Submissions. Applicant hereby authorizes PIDC to make all inquiries it deems necessary to verify the accuracy of the Application Submissions and to determine the Applicant's creditworthiness. The Applicant authorizes any individual, including the Applicant's attorney and accountant, or any credit reporting agency, or any other entity, to furnish PIDC with any information it possesses with respect to the Applicant or the Application Submissions. The Applicant further understands that any application fee or structuring fee remitted to PIDC is non-refundable. Signature/Title Date 10. Attachments Please submit ALL of the following to complete your application Business and Project Narrative (see page 2) Credit Inquiry Consent Form (see form attached) 3 years of company financial statements and/or tax returns Interim financial statements Personal financial statements of all 20% or greater owners of the business (see form attached) 2 years of personal tax returns for all 20% or greater owners of the business Application fee Tax status certification Please note that various PIDC funding sources are subject to certain public disclosure laws, including the Pennsylvania Right to Know Law. By completing this letter and listing certain information you deliver to PIDC as confidential proprietary information, or as a trade secret, we will redact such information, as well as other information, which is exempt under the applicable statute, from any request for public disclosure. PIDC has a policy that it does not discriminate in its activities and operations on the basis of age, race, creed, color, religion, sex, sexual orientation, national origin, disability, marital status or any other basis that is prohibited by United States federal, state, or local law.