RD 5001-01 Lender's Application

Form RD 5001-1
(00-00)

FORM APPROVED
OMB NO. 0000-0000

Position 3
UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

LENDER’S APPLICATION
THIS IS AN APPLICATION FOR:
(check one)

APPROVED LENDER STATUS

APPROVED AND PREFERRED LENDER STATUS

PREFERRED LENDER STATUS
2. ADDRESS (Include Zip Code):

1. NAME OF LENDER:

3. LENDER TAX ID NUMBER:

4. LENDER’S PRESIDENT/CEO:

5. CONTACT PERSON:

6. CONTACT TELEPHONE NUMBER
(

)

7. LENDER’S DUNS NUMBER:

8. CONTACT E-MAIL:

9. CONTACT FAX NUMBER:

10.LENDER’S REGULATORY ENTITY:

11.LENDER’S CHARTER STATE:

12.LENDER’S NET WORTH:

13.EXISTING RURAL DEVELOPMENT LOAN
PORTFOLIO:

14. a. LENDER’S TYPE:

15.LENDER’S ROUTING NUMBER:

YES

NO

SUPERVISED/
REGULATED

OTHER
16.LENDER’S WEB URL:

AMOUNT $_____________________

b. If Other is checked, please complete items 17
and 18.

17.LENDER’S LINE OF CREDIT: (to be completed only if “Other” is checked in Item 14)

AMOUNT

CREDIT PROVIDER NAME(S)

CREDIT PROVIDER CONTACT PERSON(S)

PHONE NUMBER(S)

18.LENDER’S LIQUID ASSETS: (to be completed only if “Other” is checked in Item 14) $ __________________________________

ATTACH THE FOLLOWING IF NOT ALREADY SUBMITTED:
19. Origination Policies and Procedures.
20. Servicing Policies and Procedures.
21. Lender’s Current Audited Financial Statements.
22. Copies of any license, charter, or other legal authority to engage in the proposed loan making and servicing activities.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0000-0000. The time required to complete this information is estimated to average 4 - 24 hours per responsee, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Form RD 5001-1 Page 1 of 2

23. Evidence of good standing: (a) if supervised/regulated lender, evidence of good standing from its regulator; (b) if non-regulated/
non-supervised lender, a certificate of good standing from the state in which the lender intends to conduct business.
24. Description of its lending history and experience, including:
(a) evidence of demonstrated expertise in loan origination, making, securing, servicing, and collecting loans; length of time in
the commercial lending business; experience with government guaranteed lending, particularly within any of the subject programs; the
range and volume of lending and servicing activity; the current status of the loan portfolio; the lender’s commercial loan fee structure;
and the level of experience of the lender’s management, lending, and servicing staff;
(b) copies of the lender’s credit evaluation policy and procedures documents, including evidence of the criteria stated in
§ 5001.16(b); the lender’s loan origination and servicing policies and procedures, including delineating ratio requirements and minimum
reserves, delineating collection, loan document compliance, post-closing financial statement analysis, verification of payment of taxes
and insurance, and maintenance of liens; and audited financial statements not more than 1 year old;
(c) documented sources of funds for funding and closing loans;
(d) office location(s) and proposed lending area(s);
(e) Pursuant to 7 CFR 5001.9(b)(1)(i), evidence showing that the lender has the necessary capital, resources, and funding capacity
to successfully meet its responsibilities; and
(f) Lenders applying for preferred lender status must provide the documentation to support compliance with 7 CFR 5001.9(c).

GENERAL LENDER CERTIFICATION
Lender certifies that it has reviewed the General Lender Certifications contained in this application. Lender’s signature represents its
agreement to comply with the limitations outlined in the General Lender Certifications.
Lender certifies that no pending or active decrimination lawsuit(s) have been filed against it alleging violation of the requirements and
provisions of Title VI of the Civil Rights Act.
Lender certifies that it meets all the criteria to be considered for the lender status it is requesting. (Pursuant to 7 CFR 5001.9.)
Lender certifies that it is in good standing with its regulators in each state in which it operates.
Lender certifies that it has not been debarred or suspended.

Lender’s Name

Date

By:
Officer Signature

Officer Title

Form RD 5001-1 Page 2 of 2