504 Loan Application
SBA Lending Solutions
Application for Financing Small Business Owner-Occupied Real Estate
and Fixed Asset Equipment Through the SBA 504 Loan
Thank you for the opportunity to work with you on the financing of your small business real estate and/ or
equipment loan. This application will help you provide the information necessary to process your loan request.
If you are not able to provide all the requested information immediately, please provide the documents that are
available so that we can begin processing your request. After we received the entire application package, any
documents needing signatures will be sent to you.
504 Application Process
To initiate a 504 loan application, it is best to first call the SCKEDD office. Our staff will review the project
(Loan Program Determination form) and suggest a general funding structure. The basic 504 application
materials are no different than what a bank typically requires (See 504 Application Checklist). The SBA 504
loan program requires a participating lender (i.e. private-sector lender also referred to by SBA as the Third Party
Lender).
The 504 Loan Assistance & Fee Agreement and a deposit must be submitted before the 504 Loan Application
can be processed.
Our staff will review the material, assess the eligibility and credit quality, and prepare an analysis for submission
to SCKEDD’s loan committee. Upon approval by the loan committee, SCKEDD will prepare the SBA 504
Application Submission forms and on completion, will submit the SBA Submission form to SBA for review and
loan decision.
Please contact SCKEDD with any questions about this application or to learn more about how we help small
businesses.
South Central Kansas Economic Development District, Inc.
A U.S. Small Business Administration Certified Development Company
200 W. Douglas, Suite 710
Phone: (316) 262-7035
Fax: (316) 262-7062
www.sckedd.org
SCKEDD 504 Loan Application – ver. February 1, 2015
1
504 Application Checklist
This checklist is provided to assist you through the process of gathering the necessary information to expedite your loan request. Please provide
the following documents to complete the 504 Loan Application. All documents provided must be signed and dated. Please mark N/A if
not applicable.
Business Information
□
504 Loan Application. Complete fully. Please sign & date.
□
Environmental Questionnaire. Separate form attached.
□
Corporate Tax Returns. Complete Federal returns for each of the previous three (3) years for the operating company and
real estate/asset holding company. Please sign & date each tax return.
□
Corporate Tax Returns. Complete Federal returns for each of the three (3) years for each affiliate. Please sign & date.
□
Year-End Balance Sheet and Income Statement. Most recent three (3) years for the operating company. Please sign &
date.
□
“Current” Balance Sheet and Income Statement. For the operating company. Please sign & date.
□
New Business: Provide a Month-by-Month Cash Flow Analysis for the first year. Please sign & date.
□
Organization Documents. Provide for the operating company and real estate/asset holding company, if applicable.
o
o
o
Corporations – Articles of Incorporation, By-Laws, Minutes of Organizational Meeting
Limited Liability Companies – Articles of Organization, Operating Agreement and Minutes of Organizational Meeting
Partnerships – Partnership Agreement
□
Franchise. Provide a copy of the executed Franchise Agreement and Franchise Disclosure Statement, if applicable.
□
Project Cost Documentation. Form attached. Provide, as applicable, Purchase Agreement, settlement sheet, contractor
bid on construction and list of equipment to be purchased with corresponding vendor estimates/costs.
Personal Information - Provide for each proprietor, partner or stockholder with 20% or more ownership
□
Personal Tax Returns. Complete Federal returns for each of the previous two (2) years. Please sign & date each tax return.
□
Personal Financial Statement. (SBA Form 413) Separate form attached. “Current” form completed jointly with spouse.
Please sign & date.
The following forms will be provided for signatures after the loan application and supporting documents are received.
□
504 Loan Assistance & Fee Agreement *
□
US Small Business Administration Application for Section 504 Loan SBA (Form 1244, PART C)
□
Personal History Statement (SBA Form 912). For all persons owning 20% or more of the operating company or asset
holding company as well as key management.
□
IRS Form 4506-T. Request for Transcript of Tax Returns.
□
CDC Client Survey. (Job creation/retention information for SCKEDD’s economic development reporting purposes.)
Note: “Current” means within 90 days of submission of the application to the SBA.
* A deposit of 1% of the SBA portion of the loan, or $2,500, whichever is less, is required to process the loan
application. SCKEDD will provide a 504 Loan Assistance & Fee Agreement upon receipt of the loan application.
SCKEDD 504 Loan Application – February 01, 2015
2
Company Information
Operating Company
Company Name
Business Address
Mailing Address
FEIN:
Zip
Zip
(if different from street address)
Principal in Charge
E-mail Address
Phone
Cell
Type of Business
Is the business a franchise?
Franchise Name
If yes, provide an executed copy of the Franchise Agreement and Franchise Disclosure Statement.
Type of business entity (check one):
Corporation
Limited liability company
Professional corporation
Sole Proprietorship
Limited liability partnership
General partnership
Limited partnership
Trust
DUNS Number
Year established/incorporated
Entity is established in the State of
Ownership: (Attach separate sheet if necessary)
Full Legal Name
Title
(First, Full Middle Name, Last)
Ownership Interest %
If the answer to any of the below questions is YES, please provide details and attach a separate sheet to the application.
YES
1. Does this company buy from, sell to, or use the services of any concern in which someone in this company
has a significant financial interest?
2. Does this business presently engage in export trade, or plan to in the future?
3. Is your product or service principally (51% or more) sold outside of Kansas?
4. Does your product or service replace other products that would normally be imported into Kansas?
5. Do you produce a product (raw materials, ingredients or components) for other Kansas firms that are
exporting the majority (51% or more) of their product beyond the boundaries of Kansas?
6. Is your business a regional distribution center which is used principally (51% or more) for inter-state
commerce?
7. Is your business a corporate multi-state headquarters used for the supervision of business activities which
occur primarily (51% or more) outside the boundaries of Kansas?
8. In the next 2 years, will you create two or more jobs as a direct result of this loan? If YES, list the type of
jobs and number of employees for each job position:
9. Will you retain 2 or more jobs over the next two years as a direct result of this loan? (Retained jobs are
existing jobs that will be saved with the loan that would otherwise be lost).
10. Current number of employees?
SCKEDD 504 Loan Application – February 01, 2015
3
NO
Company Information (continued)
About Your Business
Start-Up Businesses: Provide a written business plan. A Business Plan Outline for New Businesses can be provided upon request.
Existing Businesses: Complete the below Business History & Market Summary questions. If you already have a business plan, it can be
submitted in place of this information. Feel free to provide any additional information which you feel is important in describing your
business.
Business History & Market Summary
A. Provide information on those individuals (owners and non-owners) who will be responsible for the day-to-day operations of the
company.
Name
Responsibilities
B. When was your business established and by whom? Provide the name of the State where the business was established.
C. When did you gain control of the business?
D. What services/products do you provide/sell? Please provide a copy of any brochures or catalogs for your business.
E. What is your geographic market area?
F. How do you market your services/products? Provide all types and forms of advertising you utilize.
G. Will the project help achieve the company's goals? (Increase revenue, add products/services, improve efficiency, etc. Please be
specific.
H. If you are moving to a new business location, how will this affect your business?
SCKEDD 504 Loan Application – February 01, 2015
4
Company Information (continued)
Real Estate/Asset Holding Company
If an individual or organization, other than the Operating Company will take title (own) to some or all of the Project real estate and/or
equipment, please complete the following section.
Company Name
Business Address
Mailing Address
FEIN:
Zip
Zip
(if different from street address)
Type of business entity (check one):
Corporation
Limited liability company
Professional corporation
Sole Proprietorship
Limited liability partnership
General partnership
Limited partnership
Trust
Year established/incorporated
Entity is established in the State of
Ownership: (Attach separate sheet if necessary)
Full Legal Name
Title
(First, Full Middle Name, Last)
Ownership Interest %
Questions:
If the answer to any of the below questions is YES, please provide details and attach a separate sheet to the application.
YES
1. Do any of the principals have a trust? If YES, provide a copy of the trust.
2. Has any officer of your company ever been involved in bankruptcy or insolvency proceedings?
3. Is your business involved in any pending lawsuits?
4. Does anyone who owns, manages or directs this business or their spouses or member of their household
work for the Small Business Administration, Small Business Advisory Council, SCORE, ACE, any Federal
Agency, or the participating lender?
If YES, please provide the name and address of the person and the office where employed.
5. Does this company buy from, sell to, or use the services of any concern in which someone in this company
has a significant financial interest?
6. Does this business presently engage in export trade or plan to in the future?
7. Does any owner of 20% or more of the Operating Company own 20% or more in any other company? (If
yes, please complete Affiliates (page 17) and Government Financing (page 15).
8. One or more owners of 20% or more are non-citizens? If YES, complete the Non-Citizen Authorization
(page 18).
SCKEDD 504 Loan Application – February 01, 2015
5
NO
Project Information
Location of Project Property
Street Address
City, State, Zip
Is the project property an existing building
or is this new construction?
Provide the total square footage of the project building and the total square
footage of the building the operating company will occupy.
New
Construction
Existing
sq. ft.
Project
Building
sq. ft.
Operating Co.
will occupy
Please note: The SBA requires that your company occupy 51% of an existing building, 49% can be leased out permanently. For new
construction, you must occupy at least 60% upon move-in, additional percentage within three years, and at least 80% at the end of ten (10)
years. Twenty percent can be leased out permanently.
Tenants
If there are any tenants that will remain in the building, please provide the following information. Also please have your realtor provide
copies of all existing leases.
Tenant name
Square Footage
Lease Expiry Date
Monthly Rent
Borrower Equity Contribution
The SBA 504 Loan Program requires the small business to invest a minimum of 10% of the Total Project Costs in the project. If the
business is a start-up or less than two (2) years old, the minimum is 15%. If the building is “single/limited use purpose”, the minimum
is 15%. If the business is a start-up or less than two (2) years old AND the building is “single/limited use purpose”, the minimum is 20%.
Source of your Equity Injection
Cash
$
From Whom?
Equity in
Project Land*
$
Other
(Must be held 2+ years)
$
From Whom?
Date purchased: ____________________
Original Cost $ _____________________
NOTE: If you are borrowing any of your injection* for this project, please answer the following:
What is the amount to be borrowed?
Who are you borrowing it from?
What is the Interest Rate and length of the note for this transaction?
What is the collateral to secure this transaction?
*Borrowed Equity Contribution:
Project Property: 1) Any lien position on the Project Property must be subordinate to the 504 loan, and 2) The borrower may not pay the
loan for the equity contribution at a faster rate than the 504 loan unless it is approved by the D/FA or designee.
Non-Project Property: If the borrowed equity is collateralized by assets other than the Project Property, the borrower must demonstrate
repayment of the loan for the equity contribution from the cash flow of the business or other source.
SCKEDD 504 Loan Application – February 01, 2015
6
Project Information (continued)
Project Cost and Cost Documentation
Please provide supporting documentation for each of these items. (I.e. purchase agreement, closing settlement
statement, construction bid/contract, vendor bids/invoices for machinery/equipment and furniture/fixture to be
purchased with loan proceeds, etc.)
USE OF PROCEEDS
AMOUNT
SUPPORTING DOCUMENTS
Land Acquisition
Land Improvements
Purchase and/or Remodel Bldg.
New Construction
Purchase Machinery/Equipment
Purchase Furniture/Fixtures
Refinanced Debt
Professional Fees
Closing Costs
Construction Contingency
TOTAL
Ownership of Project Property purchased with 504 Loan Proceeds
Who will hold title to the land?
Who will hold title machinery & equipment?
SCKEDD 504 Loan Application – February 01, 2015
7
(SBA Form 1244, Exhibit #8)
Projected Income Statement
Projections for the first three years after the loan.
Year 1
A
Gross Receipts (Sales)
B
Cost of Goods Sold
C
Gross Profit (A - B)
Year 2
Year 3
EXPENSES:
D
Officer Compensation
E
Employee Wages
Administrative
Production
F
Accounting & Legal
G
Advertising
H
Rent
I
Depreciation
J
Supplies
K
Utilities & Telephone
L
Interest
M
Repairs
N
Taxes
O
Insurance
P
Other operating expenses
Q
Total Expenses (Sum of D thru P)
R
Net Profit (C-Q)
S
Less Income Taxes
T
Less Withdraws
U
Available for Debt Service
(R-S-T+I+L)
□
□
Complete a narrative explaining the basis (assumptions) for the figures in this Projected Income Statement. (pg. 9)
New Businesses: Also provide a monthly cash flow analysis for the first year with a narrative (pg. 9) explaining the basis
(assumptions) for the figures in the monthly cash flow analysis. (a cash flow “template” available upon request.)
SCKEDD 504 Loan Application – February 01, 2015
8
Narrative to the Projected Financial Statements
Provide a written narrative to the Projected Financial Statements to summarize the "activities" and
"assumptions" you made in creating the projected financial statements. This narrative will equip SCKEDD with the
necessary information needed to understand and comprehend your projected financial statements. There is no set
structure nor should specific guideline that depict which topics be included in the notes to the forecasted financial
statements. The following list provides some suggestions you may want to use when creating your narrative to the
projected financial statements. Please sign and date the written narrative and include it with your loan application.




Introduction
o
Who prepared the projected financial statements
o
General Assumptions, such as:

Management and Staff

Other, as deemed necessary
Income Statement
o
Operating Revenue(s)
o
Operating Expense(s), such as:

Salaries and related costs

Marketing Expenses

Operating expenses specific for your business operations

Depreciation and Amortization

Contracted Services

Income Tax

Other, as deemed necessary
Balance Sheet
o
Accounts Receivable
o
Inventory
o
Accounts Payable
o
Short-term Loans
o
Owner(s) Capital Account
o
Retained Earnings
o
Other, as deemed necessary
Cash Flow
o
Cash flow from operating activities
o
Cash flow from investing activities
o
Cash flow from financing activities
SCKEDD 504 Loan Application – February 01, 2015
9
Personal Income & Expense Analysis
NAME(S)
INCOMES:
MONTHLY
Available Draw
(NP + Depreciation)
Gross Salary
(Principal)
Gross Salary
(Spouse)
Rental Income
(Gross)
Interest Income
(Recurring)
Alimony
(Recurring)
Other Income: __________
(Recurring)
TOTAL INCOME
ANNUALLY
$0
$0
TOTAL EXPENSES
$0
$0
NET DISCRETIONARY INCOME
$0
$0
#DIV/0!
#DIV/0!
EXPENSES:
Residence Expense
(Rent or P&I)
Rental Mortgages
(P&I)
Rental Expenses
(Cash Exp. Less P&I)
Auto Loan(s)
(All)
Installment Loan(s)
(All)
Revolving Credit
Utilities/Phone
(Estimate)
Insurance
(All Personal)
Food
(Estimate)
Clothing
(Estimate)
Medical Expenses
(3 Yr. Average)
Income Taxes
(Historical Rate)
Property Taxes
(Historical Rate)
Alimony
(If Applicable)
Child Care
(If Applicable)
Other Expenses
(
)
Miscellaneous
(
)
(Typical range is 5% - 10% of total income)
COVERAGE RATIO (INCOME/EXPENSE)
Signature ________________________________
Date
Signature ________________________________
Date
SCKEDD 504 Loan Application – ver. February 1, 2015
10
Owner and Key Management Information
To be completed for each [ ] stockholder owning 20% or more stock; [ ] key management staff; and [ ] all officers even if they are not owners.
P lease fill in all spaces, use full first, middle, and maiden names. If an item is not applicable, please so indicate.
Legal Name
SS#:
First
Full Middle Name
Ownership Percentage
Maiden
Last
Corporate Title:
Are you a U.S. Citizen?
Date of Birth
Permanent Resident Alien?
If NO, please complete Non-Citizen Authorization (page 18).
Place of Birth
MM/DD/YY
Race
Sex
City, State, Country
If at current residence less than 10 years, provide previous residence.
Current
Residence:
Previous
Residence:
Street
Street
City
State
From:
Zip
City
to
MM/DD/YY
State
From:
to
MM/DD/YY
MM/DD/YY
Home Phone
MM/DD/YY
Cell Phone
Spouse’s Name
SS#:
First
YES
Zip
Middle
Maiden
Last
NO
Do you have a trust? If “yes”, provide an executed copy of the Trust(s).
Are you, any of your children, your parents or your spouse employed by, director of, officers of or stockholders of the participating
bank of the SBA, SCORE, ACE or any Federal Agency? If yes, please provide the name and address of the person and the office
where employed.
Have you ever filed for corporate or personal bankruptcy or been involved in insolvency proceedings? If so, please provide a copy of
the bankruptcy documentation.
Are you or your business involved in any pending lawsuits?
Do you have ownership, stock ownership, management control, previous relationships with or ties to another business or
contractual relationship in any other businesses? If yes, please complete Affiliate Form (page 17)
Do you or any of your affiliated businesses have any existing debt with SBA guarantees?
Have you or any of your affiliate businesses ever caused a loss to the Government from prior federal assistance?
A current credit report will be requested on each borrower. Are there entries on this report which will require and explanation? If
so, please attach a sheet explaining the circumstances of these entries.
Are you presently behind in any court ordered child support obligation?
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges
are brought in any jurisdiction? If YES, furnish details on separate sheet.
Have you ever been arrested in the past six months for any criminal offense. If YES, all arrests and charges must be disclosed and
explained on an attached sheet.
For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) pled guilty; 3) pled nolo
contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before
judgment)? If YES, furnish details on separate sheet.
If you answered yes to any of the above questions, please supply details on separate sheet as necessary.
Signature
____________
Date _________________________________
Personal Resume
Please fill in all spaces, use full first, middle, and maiden names. If an item is not applicable, please so indicate. Resume must be
completed by: [ ] each principal with ownership of 20% or more in the Operating Company, and [ ] any person hired by the applicant
to manage day-to-day operations.
SCKEDD 504 Loan Application – February 01, 2015
11
Name
Title
First
Full Middle Name
Maiden
Last
List all former names used and the dates each name was used. Use separate sheet if necessary.
First
Full Middle Name
Last
Dates Name Used
Education
Type of
Degree
Name & Location
of Institution
Dates Attended
From/To
Major
Degree or Certificate
Military Service Background
Branch
From
to
MM/DD/YY
Honorable Discharge?
MM/DD/YY
Rank at Discharge
Work Experience (List chronologically beginning with present employment to cover a 10 year period. Attach separate sheet if necessary.)
Company Name
Title
Dates Employed
From - To
Duties & Accomplishments
Other Business Related interest or Activities (List any training, certification, or business related interest or activities)
Signature
____________
SCKEDD 504 Loan Application – February 01, 2015
12
Date _________________________________
(SBA Form 1244, Exhibit #7)
Aging of Accounts Receivable & Account Payable
For the two schedules below, age the accounts of the company’s ten largest customers and ten largest suppliers as of the interim financial statement. Total the remaining
receivables and payable under “Others”. The totals must equal those presented in the company’s interim balance sheet. Explain substantial amounts over 90 days past due on a
separate sheet. If a complete aging of accounts has already been prepared, it may be substituted for this form.
Operating Company Name: ______________________________________________________________________
As of _____________________
Accounts Receivable
Account Name
0-30
31-60
61-90
91-120
Over 120
Total
1. _______________________________________________________________________________________________________
2. _______________________________________________________________________________________________________
3. _______________________________________________________________________________________________________
4. _______________________________________________________________________________________________________
5. _______________________________________________________________________________________________________
6. _______________________________________________________________________________________________________
7. _______________________________________________________________________________________________________
8. _______________________________________________________________________________________________________
9. _______________________________________________________________________________________________________
10. _______________________________________________________________________________________________________
Others_____________________________________________________________________________________________________
Grand Total Accounts Receivable $________________
Accounts Payable
Account Name
0-30
31-60
61-90
91-120
Over 120
Total
1. _______________________________________________________________________________________________________
2. _______________________________________________________________________________________________________
3. _______________________________________________________________________________________________________
4. _______________________________________________________________________________________________________
5. _______________________________________________________________________________________________________
6. _______________________________________________________________________________________________________
7. _______________________________________________________________________________________________________
8. _______________________________________________________________________________________________________
9. _______________________________________________________________________________________________________
10. _______________________________________________________________________________________________________
Others_____________________________________________________________________________________________________
Grand Total Accounts Payable $__________________
Signature ___________________________________________
Date ________________
SCKEDD 504 Loan Application – ver. February 1, 2015
13
(SBA Form 1244, Exhibit #10)
Schedule of Business Debt
Please list all Operating Company liabilities - contracts, notes, lines of credit and mortgages payable.
Please make sure that these correspond with the balances in the current balance sheet, as provided with this loan application.
As of: ________________________, 20___
Loan
No.
Creditor
Original
Amount
Original
Date
Total
present
balance
* Loan Status:
Current
Balance
$
Loan Status *
Maturity Date
Total
Monthly
-
Current, Delinquent, Paid In Full, or Charged Off
Signature ___________________________________________
Date ________________
SCKEDD 504 Loan Application – February 01, 2015
14
Monthly
Payment
Interest Rate
$
-
Collateral
(SBA Form 1244, Exhibit #11)
Schedule of Current & Previous Government Financing
Please list all current and previous government financing.
Please make sure this form corresponds with the balances in the current balance sheet, as provided with this loan application, if applicable.
Schedule of Debt for _______________________________________ (Name)
As of: ________________________, 20___
Loan
No.
Agency Name
* Loan Status:
Original
Amount
Original Date
Outstanding
Balance
Total present
balance
$
Maturity
Date
Interest
Rate
Total
Monthly
Monthly
Payment
Collateral
$
Current, Delinquent, Paid In Full, or Charged Off
Signature ___________________________________________
□
Loan
Status *
Date ________________
Print & complete a separate sheet for the [ ] Operating Company, [ ] each principal (individual) for both the Operating Company and Real Estate/Asset Holding Company
with an ownership interest of 20% or more.
SCKEDD 504 Loan Application – ver. February 1, 2015
15
(SBA Form 1244, Exhibit #21)
Debt Refinancing Listing
SBA 504 Projects may include a limited amount of debt refinancing as follows: 1) If the Project involves expansion (as defined by SBA) or a small business
Applicant, certain debt for fixed assets (land, building, equipment) owned by the business may be refinanced as part of the project.
The debt refinancing cannot exceed 50% of the cost of the expansion.
SCKEDD and/or SBA will determine if the debt is eligible to refinance with this SBA 504 loan application as defined by SOP 50 10 5.
Schedule of Debt for _______________________________________ (Name)
As of: ________________________, 20___
Name of Creditor
Use of Proceeds
for Original Loan
Original
Amount
Original Date
Signature ___________________________________________
□
Current
Balance
Maturity
Date
Interest
Rate
Monthly
Payment
Collateral
Date ________________
Provide copies of the following for each debt: 1) Note, 2) lien instruments and 3) transcript of account or similar document containing detailed payment history from the
lender whose debt is being refinanced reflecting that the loan has been current.
SCKEDD 504 Loan Application – February 01, 2015
16
(SBA Form 1244, Exhibit #12)
Affiliate Form
Operating Company Name: _______________________________________________
General principles of Affiliation: Concerns and entitles are affiliates of each other when one controls or has the power to control the
other, or a third party or parties controls or has the power to control both, regardless whether control is exercised, so long as the power
to control exists. SBA considers factors such as ownership, management, stock ownership, previous relationships with or ties to another
concern and contractual relationships. (Complete definition of affiliation is found at 13 CFR 121.103)
Please provide the names of all affiliated or subsidiary businesses. (Attached a separate sheet if necessary)
Percentage of Ownership
Name of Affiliated/Subsidiary Company
or Managerial Role
Signature ___________________________________________
Date ________________
Signature ___________________________________________
Date ________________
□
Please provide tax returns, Federal only, current balance sheet and income statement for each of the previous three (3)
years for each affiliate or subsidiary business listed above.
Note: Current financials means within 90 days of submission of the application to the SBA
SCKEDD 504 Loan Application – ver. February 1, 2015
17
(SBA Form 1244, Exhibit #18)
Non-Citizen Authorization
Any alien who owns 20% or more of the applicant business must provide current / valid U.S. Citizenship and Immigration Services (USCIS) documents
to the SBA lender representative (SCKEDD) to determine eligibility for the SBA loan request. The lender must verify the USCIS status of each alien,
including Legal Permanent Residents.
SCKEDD will submit a “Document Verification Request” with supporting information to the nearest USCIS office. USCIS then releases information
about the status of an alien to the requesting lender ONLY when a signed and dated authorization from the alien is attached to and submitted with the
“Document Verification Request” on that alien.
The primary documents acceptable as “supporting information” are a “Resident Alien Card” or a “Permanent Resident Card.” Copies of both the front
and the back of the card as well as an original letter like the one that follows must be provided by the applicant alien.
SCKEDD must receive verification of the status of each alien required to submit USCIS documents prior to submission of the 504 Loan Application to
SBA.
Date:
U.S. Citizens and Immigration Services
300 N. Los Angeles Street, B120
Los Angeles, CA 90012
Attn: Immigration Status Verification Unit
RE: Letter of Permission/Document Verification Request
To Whom It May Concern:
I,
, authorize the U.S. Citizenship and Immigration Services to release
(Print name)
information regarding my immigration status to South Central Kansas Economic Development District, Inc., 200 W.
Douglas, Suite 710, Wichita, Kansas 67202, Phone (316) 262-7035/Fax (316) 262-7062, because I am applying for a
U.S. Small Business Administration Loan.
Regards,
______________________________________
Signature (Must be original signature)
Address
City, State, Zip
Date of Birth
Enclosures:
□
USCIS Form G-845 (Document Verification Request); and
[ ] Resident Alien Card or [ ] Permanent Resident Card (Front & Back Copies)
Check here if this form is NOT applicable for any owners, stockholders, key management staff and company
officers.
SCKEDD 504 Loan Application – February 01, 2015
18
Customer Identification Program
Important Information about Identification Procedures when Obtaining a 504 Loan
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all Certified Development
Companies to obtain, verify and record information that identifies each person who applies for a 504 loan.
What this means for you:


When you apply for a 504 loan, we will ask for your name, address, date of birth, and other information that will allow us to
identify you.
We will also ask to see your driver’s license (or other identifying documents) and may or may not take photocopies of said
documents.
Authorization and Indemnification Agreement
I/we hereby authorize South Central Kansas Economic Development District, Inc., (hereafter referred to as “CDC” - Certified Development
Company) or any of its affiliates to make all inquiries it deems necessary to verify the accuracy of the information provided herein, and to determine my/our
credit worthiness for any purpose related to our credit transaction with them. I/we hereby certify that the enclosed application information including
attachments/exhibits are valid and correct to the best of my/our knowledge.
I/we hereby authorize the CDC to furnish relevant information to all necessary sources including various federal, state, county, and conventional
funding opportunities to obtain the best sources for the project. I/we hereby authorize the CDC to furnish relevant information to CDC’s Loan Review
Committee(s) for decision; and, to furnish relevant information to the CDC’s Board of Directors and various federal, state, and county agencies, officials
and economic development representatives for CDC’s reporting requirements regarding area economic development.
I/we authorize any company, partnership, corporation, organization or entity of whatever kind to provide the CDC with any credit, financial or
personal information held by such entity and requested by the CDC.
I/we further agree that I shall indemnify and hold the CDC harmless from any claim or cause of action arising because of incorrect, inaccurate
or incomplete information furnished by me, whether the furnishing of such incorrect, inaccurate or incomplete information was accidental or intentional
and in consideration of the CDC’s assistance, I waive all claims against the CDC, its personnel or counselors arising from this assistance.
The small business applicant and its principals as individuals, agree to indemnify and hold South Central Kansas Economic Development
District, Inc. (CDC) and/or its agents and assigns harmless from and against, any damages, cost, liability or expense attributable to release, threatened
release, discharge, manufacture, production, storage or disposal or the presence of hazardous toxic substances, on or under borrower’s property or property
in which borrower has an interest including adjoining real property and based upon claims assertble by local, state, and federal governmental authority or
other third parties against CDC or its assigns.
This indemnification will specifically survive, and is entirely independent of the debtor’s contractual obligation to repay the primary obligation
held by CDC as amended, extended, or renewed by CDC, prepayment in full of the borrower’s indebtedness to CDC; and release of CDC liens on borrower’s
real or personal property by payment, foreclosure, or other action including CDC’s discretionary abandonment of lien.
Operating Company:
________________________________________________________________________________________________________
Small Business Applicant - Signature
Date
________________________________________________________________________________________________________
Small Business Applicant - Signature
Date
Real Estate/Asset Holding Company:
________________________________________________________________________________________________________
Small Business Applicant - Signature
Date
________________________________________________________________________________________________________
Small Business Applicant - Signature
Date
As Individuals:
________________________________________________________________________________________________________
Principal - Signature
Date
________________________________________________________________________________________________________
Principal - Signature
Date
________________________________________________________________________________________________________
Principal - Signature
Date
________________________________________________________________________________________________________
Principal - Signature
Date
SCKEDD 504 Loan Application – February 01, 2015
19
504 Loan Program Information
The undersigned acknowledges that a SCKEDD (CDC) representative has explained the following with regard to the 504
Loan application:
1.
504 Loan Prepayment (Early Payoff): The SBA 504 Loan Prepayment Penalty and timing of semi-annual
prepayments – optimum time for prepayment.
SBA 504 Loans have a Prepayment Penalty based on a predetermined schedule, which is based upon the rate of
the underlying bond or debenture.
The Prepayment is equal to the following % of the outstanding balance. The prepayment schedule for a loan with
an underlying debenture rate of 5.00% is as follows:
For a 20-year Loan
For a 10-year Loan
Prepaid in Year No.:
1
105.0%
2
104.5%
3
104.0%
4
103.5%
5
103.0%
6
102.5%
7
102.0%
8
101.5%
9
101.0%
10
100.5%
After year 10
100.0%
Prepaid in Year No.:
1
105.0%
2
104.0%
3
103.0%
4
102.0%
5
101.0%
After year 5
100.0%
The TIMING of a prepayment is also critical. Your monthly payments accrue to make a semi-annual debenture
payment to the investors who fund your loan. You will be obligated to make the monthly payments up through
the next semi-annual debenture payment date. Consequently, we will typically suggest that you hold off on
making your prepayment until near the semi-annual anniversary date, so that you don’t pay a lot of additional
interest.
2. 504 Loan Payments via ACH Debit: The SBA 504 monthly loan payments will be made by an automatic electronic
withdrawal method of making payments from an account designated by Applicant. The electronic withdrawal will
occur on the first day of the month.
3. Closing Costs: The closing and legal costs associated with this loan; closing costs including estimated Title
Insurance, recording costs and other closing expenses will be financed as part of the debenture. Costs in excess of
these estimates will be deducted from the Loan Packaging Deposit. Legal fees will be financed as part of
Debenture administrative fees. (See Debt Pricing Estimate provided by SCKEDD for eligible closing and legal
fees)
4. Title Policy: The requirement that Applicant purchase an ALTA Extended Coverage Lender’s Title Policy with
ALTA Endorsements 8.2-06 (Commercial Environmental Protection Lien) & 9-06 (Restrictions, Encroachments,
Minerals), as applicable. The costs associated with the title policy is the responsibility of the small business
applicant.
5.
Assumption: The SBA Loan is assumable with prior written approval of SBA. An assumption fee of one percent
(1.0%) of the outstanding principal balance will be charged at the time of assumption.
6. 504 Interest Rate: The interest rate is determined at the time of Debenture Sale. Any discussion of interest rate at
time of application or any time after loan approval, prior to Debenture Sale, is for demonstration and example
only and does not constitute a quote or guaranty of the interest rate.
SCKEDD 504 Loan Application – ver. February 1, 2015
20
7.
Tax Return Transcripts: SCKEDD’s request for transcript of tax return(s) from IRS with borrower’s authorization
(IRS Form 4506-T).
8. 504 Occupancy Requirements: For a newly constructed facility is 60% by the Applicant at the time of loan
closing. Up to 20% may be leased for an indefinite time period. With regard to the remaining 20%, it is to be the
intent of the Applicant to move into a portion of the remaining 20% leased space within three years and to fully
occupy 80% of the facility within 10 years. For existing building, the Applicant must occupy at least 51% with no
requirement to occupy the remaining leased space. Applicant will be required and agrees to assist CDC in
obtaining Tenant Subordination(s) in a form satisfactory to the SBA and CDC for applicable leased or rented
space.
504 Project funds may not be used for tenant leasehold improvements. When title to the Project Property real
estate is held by an individual or entity other than the Operating Company and leased to the Operating Company
(OC), the OC will lease 100% of the facility and then may sublease to unrelated third parties following the
guidelines above. SBA refers to the individual or entity that owns real estate leased to the Operating Company an
Eligible Passive Company. (See #9. for more information)
9. 504 Lease Agreement Requirements: The Eligible Passive Company (EPC)/Operating Company (OC)
requirements of the SBA, including lease terms required by the SBA regulations. An EPC is an individual or
company who owns the Project Property real estate that will be leased by the OC. See SCKEDD’s 504 Lease
Agreement Requirements on our website for more detailed information.
10. 504 Appraisal Standards: A current appraisal of the project real estate must be obtained. The appraisal can be
submitted to SBA with the loan application or prior to closing. See Appraisal Standards for SBA 504 Loans on
our website for more detailed information.
11. 504 Environmental Guidelines: An Environmental Analysis must be completed. An Environmental
Questionnaire must be completed on all projects involving real estate. See Environmental Guidelines for SBA 504
Loans on our website for more detailed information.
APPLICANT:
______________________________
[insert small business applicant name]:
Signature ___________________________________________
Date ________________
Signature ___________________________________________
Date ________________
SCKEDD 504 Loan Application – February 01, 2015
21