Form 1920SX (Part B) 1920SX (Part B) Supplemental Information for PLP/SBA Express Processing

S

OMB Approval No.: 3245-0348

Effective Date:

Expiration Date:

MB Approval No.: 3245-0348

Effective Date: 02/19/2004

Expiration Date: 02/28/2007

upplemental Information for PLP/SBAExpress Processing

PLP	SBAExpress	(Revolving - Yes		No	)	(SBA Export Express - Yes				No	)
	EWCP	(Revolving - Yes		No	)		IT	Patriot Express

Borrower Name:

Trade Name (dba):

(if no trade name, enter “NA”)

Borrower Contact:

Mr

Ms

First

MI

Last

Borrower Street:

Borrower Zip Code:

Borrower Phone #:

Borrower SSN #:

(must include SSN # for principal of borrower)

#

Employer ID #:

(if available)

Borrower State:

(2 letter abbreviation)

Borrower County:

Borrower City:

Lender Name:

Lender ID #:

Loan Maturity:

(in months)

Loan Amount:

$

SBA Guaranty %:

%

Construction Amount:

$

New Construction?

Variable Interest Rate?

Variable Interest Rate: P+

%

Initial Bank Interest Rate:

%

Exporter?

Yes

No

If yes, amount in export sales applicant has projected loan will support

$

New Business
Outstanding SBA Loan
New Loan is Collateralized

Rural

or

Urban

NAICS Code:

Number of Employees:

Number of Jobs Created:

Number of Jobs Retained:

Franchise?

Franchiser’s Name:

SBA USE ONLY:

Sole Proprietorship?

Partnership?

Corporation?

Other?

Veteran/Patriot Express Status**	1=Non-Veteran; 2=Veteran-Other; 3=Service-Disabled Veteran; 4=Not Disclosed. (Patriot Express codes are on next page)
Gender**	M=Male; F=Female; N=Not Disclosed
Race**	1=American Indian/Alaska Native; 2=Asian; 3=Black/African-American; 4=Native Hawaiian/Pacific Islander; 5=White/Caucasian; X=Not Disclosed
Ethnicity**	H=Hispanic/Latino; N=Not Hispanic/Latino; Y=Not Disclosed
Owner #		% Owned *	Veteran/Patriot Exp.**	Gender	Race	Ethnicity	Please reference the above to complete this table for each 20% or greater owner of the primary business associated with the borrower. More than one race may be selected.

Were any other SBA loans with maturities of more than 12 months made to the borrower in the last 90 days? If so, please complete for each loan	SBA Loan #	SBA	Loan	SBA	Term
		Approval Date	Amount	Guaranty %	(in months)

SBA Form 1920SX (Part B) (Ver. 6/01/07) Page 1 of 2

Supplemental Information for PLP/SBAExpress Processing

Borrower Name:

Use of Loan Proceeds	Amount
Purchase Land	$
Purchase Land and Improvements	$
Purchase Improvements	$
Construct a Building	$
Add an Addition to a Building	$
Make Renovations to a Building	$
Pay Off Interim Construction Loan	$
Pay Off Lender’s Interim Loan	$
Make Leasehold Improvements to a Building	$
Purchase Equipment	$
Purchase Fixtures	$
Purchase Inventory	$
Pay Trade or Accounts Payable	$
Pay Notes Payable	$
Pay Outstanding Debt	$
Purchase a Business	$
Purchase All Outstanding Stock	$
Pay SBA Loan	$
Working Capital	$
Pay the Guaranty Fee	$
Other	$
Total	$

** The gender/race/ethnicity/veteran data (except as described below) is collected for statistical purposes only. Disclosure is voluntary and has no bearing on the credit decision.

Eligibility Categories for Patriot Express loans only (Mandatory for eligibility purposes):

2=Veteran other than service-disabled

3=Service-disabled Veteran

5=Active Duty military eligible for the Transition Assistance Program

6=Reservist or National Guard member

7=Current spouse of any of the four groups listed above

8=Widowed spouse of a service member or veteran who died of a service-connected disability

* For Patriot Express loans, Patriot Express eligible owners must equal at least 51 percent of the total ownership in the “Owner” block on Page 1.

Lender Contact:

Mr

Ms

First

MI

Last

Lender Contact Phone #:

Lender Contact Fax #:

The estimated burden for completing this form is 30 minutes. You will not be required to respond to any collection of information unless it displays a currently valid OMB Control Number. Comments on the burden should be sent to U. S. Small Business Administration (SBA), Chief, AIB, 409 3rd Street, SW, Washington, DC 20416 and Desk Officer for SBA, Office of Management and Budget, New Executive Office Building, Rom 10202, Washington, DC 20503. OMB Control Number 3245-0348. PLEASE DO NOT SEND FORMS TO OMB.

SBA Form 1920SX (Part B) (Ver. 6/01/07) Page 2 of 2