Loan Request - Individual SAGE Student
Business Information:
Business Name:
_______________________________________________________
Date Started:
_______________________________________________________
Individual Owner(s)
Name:
_______________________________________________________
Individual Owner(s)
Address:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Individual Owner(s)
Phone Numbers
_______________________________________________________
_______________________________________________________
Individual Owner(s) Email Address
_______________________________________________________
How Much Money (in U.S. Dollars) Are You Requesting? ____________________________
(Maximum: $100 for Individuals)
Purpose of the Loan: ___________________________________________________________
_____________________________________________________________________________
How Would You Like to Pay the Loan Back After One Year from the Date the Loan
Proceeds are Received?
___ In one lump payment, plus 5% interest
___ In four equal payments, payable at the end of each of the next four quarters after Year
1, using a 5% annual interest rate
___ In 12 equal payments, payable at each of each of the next twelve months after Year 1,
using a 5% annual interest rate
Business Plan
In a separate attachment, please answer the following questions (if you have a formal
business plan, include your plan, but make sure each of the following questions is
addressed):
1. Please provide a brief history of your business, future plans and projections, and
describe your products and/or services and competition.
2. Please describe your previous business experience. (Include business
background, management experience, and training, or include a resume.)
3. What is your business’s competitive advantage? What makes it different?
4. At what price will you sell?
5. Where will you be selling your goods or services?
6. How will you advertise your business?
7. Are there any environmental concerns about your business?
8. Please include a projected balance sheet at the end of the first year; also include a
projected income statement for your business for the first year.
9. Include a personal list of assets and liabilities (e.g., a personal balance sheet).
BUSINESS INFORMATION
Business Name
Address
Telephone (
)
Individual Name(s)
Address
Telephone (
)
Date of Birth:
Proprietorship __________
Partnership _________
Non-Profit ________
Individual
Sub-Chapter S _____
________
Corporation _______
LLC _______
Ownership Distribution: (List partners, owner names)
Note: Attach separate sheet if additional
space needed.
Name
Title
# of Months
%
Name
Title
# of Months
%
Name
Title
# of Months
%
Nature of Business
Date Established
Months at Present Location
[
] Own
Number of Employees
[
] Lease
FINANCIAL INFORMATION
Bank of Account (if any)
Credit Relationships:
Name of Creditor
Account Number
Please provide details of your business credit relationships below:
Original Loan
Amount
Purpose of Loan
Amount
Presently Owing
$
$
$
$
$
$
Repayment Terms
Maturity
Date
LOAN REQUEST
Amount of Loan Requested (in U.S. Dollars)
$ ________________
Type of loan
[
] One year simple interest loan, with principal
and interest payable at 5% at the end of loan contract
is signed
[
] One year installment loan, with principal and
interest payable at an annual interest rate of 5% in four
quarterly installments starting one year after the loan
contract is signed
[
] One year installment loan, with principal and
interest payable at an annual interest rate of 5% in 12
monthly installments starting one year after the loan
contract is signed
[
] Other (to be negotiated)
[
] Other (State type of loan required and loan
Specific Loan Purpose (Check all that apply)
[
] Working Capital
[
] Finance Purchase of Inventory
[
] Finance Purchase of Equipment
__________________________________
[
] Finance Purchase of Real Estate
__________________________________
[
] Finance Purchase of Business
__________________________________
[
] Refinance Existing Loan or Debts
__________________________________
purpose)
CERTIFICATION
The undersigned certifies that, to the best of his or her knowledge and belief, all information
contained in this loan application and in the accompanying statements and documents is true,
complete, and correct. The undersigned agrees to notify the SAGE Bank immediately of any
material changes in this information
Business Name (print):
Applicant Signature(s):
Date:
Applicant Title:
SAGE Teacher or
Advisor (s) Signature:
Date:
SAGE Country
Coordinator Signature:
Date:
The SAGE Country Coordinator will submit the application to SAGE Headquarters for loan
processing. If approved, we will forward a promissory note for you to sign. After this note is received
by SAGE Headquarters, you will receive your loan proceeds within two weeks.