Loan Application
This loan application is designed to provide Finance Fund with necessary information to evaluate your
loan request. Please indicate N/A in fields that do not apply to your project.
Date of Application:
Applicant Information
Applicant/Company
Name: (Full Legal Name)
Street Address:
City:
State:
Zip:
County:
Phone:
Fax:
Mailing Address: (if different
than street address)
City:
State:
Zip:
Website:
Contact Information
Contact Person:
Contact Phone:
Title:
Contact Email:
Executive Director:
Executive Director Email:
Company Profile
Structure of Business: (Check One)
C-Corporation
LLC or LLP
S Corporation
Partnership
Sole Proprietorship
Other
Fed Tax ID/EIN #:
NAICS:
Month/Year Business was Established:
Company Bank Reference
Name of Primary Bank:
Bank Address, City &
State:
Loan Application 10.1.14
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Loan Application
Bank Officer:
Bank Account Number:
Checking
Savings
Bank Routing Number:
Ownership of Applicant Company
Percentage
Owned
Name
Personal
Guarantor
Yes
No
Yes
No
Yes
No
Guarantor Information (if applicable – all individuals with >20% ownership)
Name:
Name:
Address (with City,
State and Zip):
Address (with City,
State and Zip):
Contact:
Contact:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
% of Ownership:
% of Ownership:
Personal Net
Worth:
Personal Net
Worth:
Key Management (Attach resumes or biographies as Exhibit A)
Name
Title
Yrs. with
Co.
THE PROJECT
Amount of Loan Request
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Loan Application
Loan Category Use (Check all that apply):
Machinery & Equipment
Information/Technology System
R/E Acquisition
R/E Renovation/Addition
Inventory
Working Capital
Other
$
$
$
$
$
$
$
Please provide background information and the experience of the key individuals responsible for
implementing the project (See Required Attachments):
Project Description Please provide an Executive Summary that describes the Project—purpose, goals, objectives, and
advantages. If this is a collaborative effort, please elaborate.
Project Information
Project Name:
Project Address or
Parcel ID Number:
Project City:
State:
Zip (+4):
Project County:
Project Community:
Project Census Tract
Number(s):
Census Tract Info available at: http://www.cdfifundhelp.gov/index.asp?section=NMTC
Major Urban Area (total urban/suburban population >1 million
Community Type:
Minor Urban Area (total urban/suburban population <1 million
Non-Metropolitan Area (census tract located outside of an MSA)
Community Type Info available at: http://www.census.gov/2010census/
Timeline of Construction
Project:
Anticipated impact on
your services and cash
flows (revenues and expenses)
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Loan Application
Project Tax ID Number:
Project Information – Equipment Purchase (if applicable)
Equipment Description (detailed):
Equipment Purchase:
Before closing of the loan
After closing of the loan
Site Control Information (check one)
Own
Options
Lease/Rent
Not Controlled
In Contract
Please explain lease/rent terms, options, or
purchase contract:
Are there any liens or claims on the property:
Yes
No
If yes, please explain:
Mortgage Holder Information (if applicable)
Mortgage Holder Name:
Address:
City:
State:
Zip:
Contact Person:
Phone:
Fax:
Email:
Mortgage Balance:
Origination Date:
Project Sources of Funds
Source (1)
Amount
Type (2)
Status (3)
$
$
$
$
$
$
Loan Application 10.1.14
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Loan Application
$
$
Note: Right click on “0” to left and select Update Field to
add (autosum) source amounts in table.
Total Sources 0
(1) Name of Source
(2) Debt, Cash, Grant, Owner’s Equity, Tax Credit Equity, In-kind, Other
(3) Committed (legally binding commitment from source); Term Sheet (source is not legally bound); Application
Pending (submitted but not yet decided); Disbursed; Other: Please explain
Project Uses of Funds
Use (1)
Amount
Who will perform the activity?
$
$
$
$
$
$
$
$
Note: Right click on “0” to left and select Update Field to
add (autosum) use of funds amounts in table.
Total Uses 0
(1) Bldg. or Land Acquisition; Bldg. Renovations; Leasehold Improvements; Machinery and Equipment;
Construction Hard Costs; Construction Soft Costs; Closing Costs, Working Capital
Project’s Geographic/Demographic Information
Please select one:
Ohio
Indiana
Kentucky
House District #:
Senate District #:
US Congress District #:
Local Government:
FINANCIAL INFORMATION
Financial Summary Please provide the financial information requested in the “Required Attachments” section below. In
addition, please comment on any significant changes in revenue makeup, expenses or balance sheet items from Year to Year, or
variations from Budget, such as:
Income Statement
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Loan Application
Changes in Revenues
Explanation of Item
Increases or Decreases in Expenses
Explanation of Item
Item:
Item:
Item:
Item:
Item:
Item:
If you have had any losses during the last 3 years, please briefly discuss any contributing
factors:
Debt Schedule
Please list all the sources of debt below:
Lender
Amount
Outstanding
Maturity Date
Monthly
Payment
Purpose
Value
How Financed
Please discuss notable increases in fixed assets:
Item
Purpose
Please provide details on Accounts Receivable:
Total A/R as
of most
recent fiscal
quarter
Loan Application 10.1.14
Date
% Aged Less
than 30 days
% Aged 3160 Days
% Ages 6190 Days
% Aged Over
90 Days
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Loan Application
Has your accounts receivable quality remained consistent? Please briefly discuss reasons for
any change in quality:
Please use this space to comment on other variations or elements of your financial statements
that may require clarification:
Equal Credit Opportunity Act
The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants
on the basis of race, creed, color, religion, national origin, sex, sexual orientation, age, disability,
or any political or union affiliation because all or part of the applicant’s income derives from any
public assistance program; or because the applicant has in good faith exercised any right under
the Consumer Credit Protection Act. The Federal agency that administrates compliance with this
law concerning this creditor is The Federal Trade Commission (FTC). Visit www.ftc.gov for more
information.
Certification Statement
I/We agree to all of the terms and conditions applicable to the request and authorize Finance
Fund to investigate my/our personal and business financial credit history as necessary to process
a loan application. Each of the undersigned authorize any person or consumer reporting agency
to give you any information it may have on the undersigned. Each of the undersigned authorizes
you to answer questions about your credit experience with the undersigned and authorize you to
release information if the request is approved, to consumer and business reporting agencies and
others whom we believe have a legitimate need for the information. The undersigned, in applying
for financial assistance from Finance Fund, recognizes that prior to receiving any financial
assistance they agree to comply with all federal, state and local laws and regulations to the extent
that such are applicable.
The foregoing and any supplementary information are warranted by the undersigned to be true,
accurate, and not misleading as of the date submitted and are furnished to induce you to make
the loan applied for, which, if granted, the proceeds thereof will be used only for the purpose
stated above. The undersigned knows that you rely and continue to rely theron until written notice
of any change therein is received by you. The undersigned will give you immediate written notice
of any material changes in the undersigned’s financial condition, including any lawsuit, begun or
threatened, the effect of which may be to materially alter the said condition.
Agreements and Representations:
1. You represent to Finance Fund that you are authorized to sign this application on behalf
of the applicant, and that you have the title indicated below, and that no other person(s)
is/are required to sign this application in order to bind the applicant or to make any of the
representations, agreements, or other information in this application accurate, effective,
and legally binding.
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Loan Application
Business Name:
Authorized Signature:
Date:
Printed Name:
Title:
Authorized Signature:
Date:
Printed Name:
Title:
Guarantors/Co-Signers
Guarantors/Co-Signers must personally sign this application. If there are more signatures
required than signature lines available, please print this signature page for the required number
of signatures and include it with this application.
Signature:
Print Name:
Date:
Signature:
Print Name:
Date:
Required Attachments The following list of required attachments is considered part of the loan application. Each of the
exhibits must be tabbed and attached to the back of the loan application.
Exhibit A:
Exhibit B:
Exhibit C:
Exhibit D:
Exhibit E:
Exhibit F:
Exhibit G:
Exhibit H:
Exhibit I:
Exhibit J:
Exhibit K:
Exhibit L:
Exhibit M:
Exhibit N:
Business Plan and History of Business
Business Financial Statement (within 60 days)
Business Federal Income Tax Returns (previous 3 years)
Personal Federal Income Tax Returns of all owners with 20% or more ownership
interest
Projected Monthly Cash Flow Statement (first year)
Projected Annual Cash Flow Statement (second and third years)
Projected Income/Expense Statement (P&L Statement)
Personal Financial Statements (within 60 days)
Sales Contract(s) and Bids (when applicable)
Organizational Documents (Articles of Incorporation, By-Laws, Certificate of Good
Standing)
List of Board of Directors with the following information for each member: member
name, principal employer, occupation, address, term, Board position, gender,
race/ethnicity. (Required for Nonprofits Only)
Resolution to Borrow with Two (2) Board Signatures (Required for Nonprofits Only)
Resumes of Senior Management and Individual(s) responsible for implementing
the project. (Executive Director, CFO or equivalent, Project Manager, etc.)
Other Documentation Important to the Application (i.e. old appraisals, old
environmental reports, etc.)
Submittal of Application
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Loan Application
Application can be mailed to: Finance Fund, 175 South Third Street, Suite 1200, Columbus,
Ohio 43215; sent by fax to: (614) 221-7493 or emailed to Tara Campbell, Vice President of
Lending at tcampbell@financefund.org with a copy to: Ginny Edgington, Associate Manager of
Programs at gedgington@financefund.org.
Questions concerning this application should be directed to Tara Campbell at (614) 568-5047 or
via email at tcampbell@financefund.org.
Loan Application 10.1.14
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