OMB Approval No.: 3245-0355 Expiration Date:
ELIGIBILITY INFORMATION REQUIRED FOR
GULF OPPORTUNITY PILOT LOAN PROGRAM SUBMISSION
Fill out all of this section. If a question in this section is answered “No,” the loan is not eligible.
Applicant Name ______________________________________________________________________________________________
Lender Name ________________________________________________________________________________________________
Purpose of Loan ______________________________________________________________________________________________
Describe Type of Business ______________________________________________________________________________________
Applicant is an operating business organized for profit, is located in United States, has demonstrated a need for the
desired credit, and the desired credit is not otherwise available on reasonable terms from non-Federal sources. YES___NO___
The products and/or services of the Applicant business are available to the general public. YES___NO___
Size and Affiliation
Primary industry of Applicant_______________________________________________NAICS Code of Applicant_______________
Average annual receipts of Applicant Business (excluding affiliates) over last 3 completed fiscal years__________________________
No. of employees of Applicant Business___________________________ SBA size standard for Applicant ____________________
OR (alternative size standard) tangible net worth is ___________ (not in excess of $7 million) and average net income after Federal income taxes for the preceding two completed fiscal years is ___________ (not in excess of $2.5 million).
The combined size calculation of applicant and its affiliates meets the size standard for the applicant’s primary industry or the size standard for the primary industry of the applicant and its affiliates, whichever is higher. YES___NO___
If size standard is exceeded by no more than 25%, Applicant agrees to use the assistance within a labor surplus area. YES___NO___
CHECK IF APPLICABLE:
___Applicant has possible affiliates. If checked, provide the following information in attachment to this form:
List possible affiliates, discuss possible bases of affiliation and determine if affiliation exists. If affiliation exists, state
1) combined average annual receipts over last 3 completed fiscal years or number of employees for applicant and all affiliates or 2) combined tangible net worth and combined average net income for applicant and all affiliates.
___Applicant business is a franchise. If checked, answer the following question. If “No” loan is not eligible.
Franchisee has the right to profit and risk of loss commensurate with ownership and there are no excessive
restraints on the sale of the franchise interest. YES___NO___
Principals of the Applicant
All principals of business are either U.S. citizens or non-U.S. citizens whose status is being verified with USCIS. For non-U.S. citizens, the lender has obtained a copy of the individual’s USCIS documentation and submitted a USCIS Form G-845, “Document Verification Request” with supporting information to the appropriate USCIS office. In addition, the lender will not close and disburse the loan prior to receiving confirmation from USCIS that the alien status of all principals meets SBA’s policies. YES___NO___
If “Yes,” CHOOSE the ONE that applies (If neither applies, the loan is not eligible):
____The business is at least 51 percent owned by individuals who are U.S. citizens and/or who have Lawful Permanent Resident (LPR) status, which lender will verify with the USCIS prior to first disbursement, and control the management and daily operations of the business; OR
____The business is at least 51 percent owned by aliens with an alien status other than LPR, which lender will verify with the USCIS prior to first disbursement, the lender has determined that continual and consistent management of the business has been provided by a U.S. citizen or by an LPR (which lender will verify with the USCIS prior to first disbursement) for at least one year and will continue indefinitely AND U.S. collateral is pledged sufficient to pay the loan in full at any time. (Businesses less than one year old do not meet these requirements.)
No Associate of the Applicant is incarcerated, on probation, on parole, or under indictment for a felony
or a crime of moral turpitude. YES___NO___
The maturity of the loan does not exceed the maximum allowable by SBA and is the shortest appropriate term
commensurate with repayment ability of the Applicant. If the loan is revolving, the maturity does not
exceed seven years. YES___NO___
SBA guaranty percentage on this loan does not exceed 85% OR if submitted under the American Recovery
and Reinvestment Act of 2009 (the “Recovery Act”), does not exceed 90%. YES___NO___
.
The aggregate amount of the SBA portions for this application and all outstanding loans to Applicant and its
affiliates does not exceed $1,500,000. YES___NO___
The interest rate of the loan does not exceed 6.5% over prime rate for loans of $50,000 and less or 4.5%
over prime rate for loans over $50,000. YES___NO___
Applicant does not have a non-SBA-guaranteed loan made by any lender at or about the same time for the same or
similar purpose as this loan, with a lien position senior to this loan (“Piggyback Loan structure”). YES___NO___
CHECK ANY ITEMS THAT ARE APPLICABLE IN THIS SECTION.
___Applicant is or does one of the following. If checked, loan is not eligible.
primarily engaged in the business of lending
a passive business that holds real and/or personal property to receive rent or lease income and does not provide sufficient services to deem it active and is not an Eligible Passive Company discussed below
bail bond company
life insurance company
does business in a foreign country (except for loan under the International Trade program)
pyramid sale distribution plan
any illegal activity
principally engaged in teaching, instructing, counseling or indoctrinating religion or religious beliefs, whether in a religious or secular setting.
consumer or marketing cooperative
earns 1/3 or more of its gross annual revenue from packaging SBA loans
derives directly or indirectly more than 5% of its gross revenue through the sale of products or services, or the presentation of any depiction or displays, of a prurient sexual nature or that presents any live performances of a prurient nature
primarily engaged in political or lobbying activities
a speculative business (such as oil wildcatting, mining and research & development)
___Applicant is a pawn shop. If checked, answer the following question. If “No” loan is not eligible.
More than 50% of Applicant’s income for the previous year was from the sale of merchandise
rather than from interest on loans. YES___NO___
___Applicant is a motel, trailer park, campground or similar type of business. If checked, answer
the following question. If “No” loan is not eligible.
Applicant derives 50% or more of its gross annual income from transients who stay for periods of
time not exceeding 30 days. YES___NO___
___Any of gross annual revenue of Applicant business is derived from gambling. If checked, answer the
following question. If “No” loan is not eligible.
The revenue is from legal gambling activities and comprises 1/3 or less of gross annual revenue of
Applicant business and the business is not a racetrack, casino or otherwise have gambling as its
reason for being. YES___NO___
___Applicant is a private club or business. If checked, answer the following question. If “No” loan is not
eligible.
Business does not limit the number of memberships for reasons other than capacity. YES___NO___
___Applicant is a government-owned entity. If checked, answer the following question. If “No” loan
is not eligible.
Applicant is business owned or controlled by a Native American tribe, but is a separate legal
entity from the tribe. YES___NO___
___Applicant is an Eligible Passive Company (EPC). If checked, fill in the blanks and answer the
following questions. If “No” loan is not eligible. Attach additional sheet with Names and Legal Forms
if more than one OC. References below to OC mean each OC.
Name of Operating Company (OC)_____________________________________________________________________________
Legal Form of Entity of OC___________________________________________________________________________________
The EPC will use the loan proceeds to acquire or lease, and /or improve or renovate real or personal
property (including eligible refinancing) that it leases 100% to one or more OCs. YES___NO___
The OC is an eligible small business and the proposed use of proceeds would be an eligible use if
the OC were obtaining the financing directly. YES___NO___
The EPC (with the exception of a trust) and the OC each are small under SBA’s size standards. YES___NO___
The EPC is eligible as to type of business, other than being passive. YES___NO___
The lease between the Eligible Passive Company and the Operating Company will be in writing,
will have a remaining term at least equal to the term of the loan (including options to renew exercisable
solely by the Operating Company), will be subordinated to SBA’s lien on the property and the rents
will be assigned as collateral for the loan. YES___NO___
The OC will be a guarantor or co-borrower. If loan proceeds include working capital or assets
to be owned by the OC, it will be a co-borrower. YES___NO___
Each 20% or more owner of the EPC and each 20% or more owner of the OC will guarantee
the loan. YES___NO___
The aggregate amount of the SBA portions for this application and for all outstanding loans to
the EPC, the OC, and their affiliates does not exceed $1,500,000. YES___NO___
Neither the EPC nor the OC is a trust or SBA requirements regarding trusts are met. YES___NO___
___To provide or refinance funds used for payments, distributions, or loan to Associates of the Applicant,
except payment of ordinary compensation for services rendered. If checked, loan is not eligible.
___For debt refinancing. If checked, ATTACH A DEBT SCHEDULE SHOWING THE TERMS OF THE DEBT TO
BE REFINANCED AND THE JUSTIFICATION FOR THE REFINANCING. Also, answer the following
questions. If “No,” loan is not eligible.
Refinancing will provide a substantial benefit to Applicant of at least 20% needed improvement to
cash flow or refinanced debt is short-term, involves a balloon payment, or is a long-term loan that is interest
only. If more than one debt is refinanced, the new debt will have at least a 20% cashflow improvement over the combined cashflow of the debt being refinanced. YES___NO___
Existing debt no longer meets the needs of the Applicant. YES___NO___
If existing debt is between the Applicant and the requesting SBA lender, in addition to the previous
two bullets, the debt has been current (no payment beyond 29 days past due) for at least the last 36 months
AND the new loan will not reduce the lender’s existing credit exposure to the borrower. YES___NO___
Proceeds will not pay a creditor in a position to sustain a loss causing a shift to SBA of all or
part of a potential loss from an existing debt. YES___NO___
Debt to be refinanced is NOT an SBA-guaranteed loan unless it meets the following exception: the transaction
is the purchase of an existing business that has an existing SBA loan that is not with the requesting
SBA Express lender. YES___NO___
Loan will not refund debt to an SBIC. YES___NO___
Loan will not repay third party financing for any existing 504 project. YES___NO___
Loan will not repay delinquent IRS withholding taxes, sales taxes or similar funds held in trust. YES___NO___
___For a purpose that will not benefit the small business. If checked, loan is not eligible.
___To fund or refinance a change in ownership. If checked, answer the following questions. If “No” loan
is not eligible.
The change will promote the sound development or preserve the existence of the Applicant business. YES___NO___
The change is an arm’s-length transaction supported by a determination of value. The loan file is
well documented regarding the valuation and includes the substantiating analysis. If the valuation
analysis is performed by the lender’s loan officer, a synopsis of the analysis is attached. If buyer and
seller are related, transaction is supported by independent third party valuation. YES___NO___
Change is 100% of ownership or a business repurchasing 100% of one or more of its owners’
interests. YES___NO___
If the loan is paying off an SBA guaranteed loan of the seller, the loan being paid off is not
with the same lender submitting this loan request. YES___NO___
___For construction or refinance of construction of a new building. If checked, answer the following
questions. If “No” loan is not eligible.
If building will contain rental space, Applicant (or Operating Companies) will continue to occupy
at least 60% of the rentable property for the term of the loan; lease long term no more than 20% of the
rentable property to one or more tenants; plans to occupy within three years some of the remaining
rentable property not immediately occupied or leased long term; and plans to occupy within ten years
all of the rentable property not leased long term. YES___NO___
Community improvements do not exceed 5 percent of construction proceeds of this loan. YES___NO___
___To provide funds for or refinance of acquisition of land or existing building or for renovation or reconstruction
of an existing building. If checked, answer the following questions. If “No” loan is not eligible.
Applicant (or Operating Companies) will occupy at least 51% of the rentable property. YES___NO___
Loan proceeds will not be used to remodel or convert any rental space in the property. YES___NO___
___To provide funds for or refinance of leasehold improvements. If checked, answer the following question.
If “No” loan is not eligible.
Loan proceeds will be used to improve space occupied 100% by Applicant. YES___NO___
___To provide funds to guarantee or fund a letter of credit. If checked, loan is not eligible.
Special Program Requirements
___ Business applicant is located in, locating to, or relocating in the counties/parishes that have been Presidentially-declared disaster areas resulting from Hurricanes Katrina or Rita, plus any parishes/counties contiguous to those parishes/counties. Additionally, the loan proceeds will be used to support the business’s operations within the eligible parish/county. Business address where the business is located or will be located:
(street number and name)_____________________________________(county/parish)_______________________(state)________
If “No” loan is not eligible for this program. YES___NO___
___Loan is one of the following special purpose loans (Loan is not eligible for this program):
Disabled Assistance Loan Program (DAL)
Energy Conservation
International Trade Loans or SBA Export Express loans
Qualified Employee Trusts (ESOP)
Pollution Control Program
CapLines Program (including Builders Loan Program)
Community Adjustment and Investment Program (CAIP)
___Applicant is or does one of the following (Loan is not eligible for this program.):
Agricultural or farm business
Fishing or shore operation (including commercial fishing activities and the construction of new fishing vessels)
Medical facility involving any type of extended care/assisted living situation
Mine (including sand and gravel pits)
Has operations, facilities, or offices located overseas (other than those strictly associated with the marketing and/or distribution of products exported from the U.S.)
Is engaged in teaching, instructing, counseling or indoctrinating religion or religious beliefs, whether in a religious or secular setting
Derives directly or indirectly more than de minimis gross revenue through the sale of products or services, or the presentation of any depiction or displays, of a prurient sexual nature or that presents any live performances of a prurient nature.
___Applicant or Affiliate(s) has/have existing SBA loans(s). If checked, answer the following question. If “No” loan is not eligible.
The loan number of the SBA loan is ____________ and
The existing SBA loan(s) is/are current. YES___NO___
___Question 1, 2, or 3 on SBA Form 2281, Gulf Opportunity Pilot Loan Program Borrower Information Form, for this
application is answered “Yes.” (Loan is not eligible for this program.)
___ Lender is aware that the application was previously submitted to SBA under any SBA program (except disaster), including SBAExpress, CommunityExpress, PLP, CLP, LowDoc, or regular 7(a). (Loan is not eligible for this program.)
___Loan will have primary collateral that will not meet SBA’s environmental requirements or that will require
use of a non-standard indemnification agreement. (Loan is not eligible for this program.)
___Business previously defaulted on a Federal loan or Federally assisted financing that resulted in the Federal government
or any of its departments or agencies sustaining a loss; or a business owned or controlled by a principal or any
Associates which previously owned or operated a business which defaulted on a Federal loan (or guaranteed a
loan which was defaulted) and caused the Federal Government or any of its agencies or departments to sustain
a loss in any of its programs, including any compromise agreement with any such agency/department; or a
principal was the recipient of a student loan that is in delinquent status. (Loan is not eligible for this program.)
___ Application is being submitted under the Recovery Act.
If checked, answer the following questions. If “No” loan is not eligible to be submitted under the Recovery Act.
● No individual who is an alien unlawfully present in the United States has an ownership interest in another concern that has an ownership interest in the applicant. YES___NO___
● Loan proceeds will not be used for a casino, or other gambling establishment, golf course, aquarium, zoo or
swimming pool. YES___NO___
All statements must be answered as “true” for the loan request to be submitted under SBA Express or one of the Pilot Loan programs.
No SBA employee, the employee’s close relative or a member of the employee’s household is an employee, officer, director, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
No former SBA employee separated from SBA for less than one year is an employee, officer, director, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
No individual currently involved in a Small Business Development Center program, the individual’s close relative or a member of the individual’s household is an employee, officer, director, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
No member of Congress or an appointed official or employee of the legislative or judicial branch (or a close relative or household member of such an individual) is a sole proprietor, general partner, officer, director, employee, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
If an Associate** of the small business or member of any Associate’s household is a GS-13 or higher government employee or a Major or Lieutenant Commander or higher in the military, the small business applicant has submitted to the Lender a statement of no objection by the pertinent government department or military service. True____
No member or employee of a Small Business Advisory Council or a SCORE volunteer (or a close relative or household member of such an individual) is a sole proprietor, general partner, officer, director, employee, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
No employee of a community organization such as a certified development company or microlender (or a close relative or household member of such an individual) is a sole proprietor, general partner, officer, director, employee, attorney, agent, creditor or debtor, or has a financial interest in the Applicant. True____
No community organization or its officers or its directors have a significant financial interest in the Applicant unless the organization has been inactive in packaging SBA loans for at least two years prior to the application date. True____
No Lender or Associate** of Lender has a real or apparent conflict of interest with Applicant, any of Applicant’s Associates, or any of the close relatives of Applicant’s Associates. True____
No Lender or Associate or close relative of an associate of the lender has a significant direct or indirect financial or other interest in the applicant, or has had such an interest within 6 months prior to the date of the application. True____
No Associate of a Lender is incarcerated, on parole, or on probation or is a convicted felon or has an adverse final civil
judgment (in a case involving fraud, breach of trust, or other conduct) that would cause the public to question the Lender’s business integrity. True____
No Lender or any Associate of Lender has accepted funding from a source that restricts, prioritizes, or conditions the types of small businesses that Lender may assist under an SBA program or that imposes any conditions or requirements upon recipients of SBA assistance inconsistent with SBA’s loan programs or regulations. True____
None of the Loan proceeds will directly or indirectly finance purchase of real estate, personal property or services from Lender or an Associate of Lender. True____
Neither the Applicant, an Associate of Applicant, close relative nor household member of an Associate of Applicant is required to invest in Lender. True____
None of the proceeds of the loan will be used to acquire space in project for which lender has issued a real estate forward commitment. True____
(**Associate of a Lender is an officer, director, key employee, or holder of 20 percent or more of the value of the Lender’s stock or debt instruments. An Associate of a small business is an officer, director, owner of more than 20 percent of the equity, or key employee.)
ATTACH SHEET FOR COMMENTS REGARDING ANY OF ABOVE ANSWERS THAT REQUIRE EXPLANATION OR REGARDING ANY OTHER RELEVANT ELIGIBILITY ISSUES.
Is additional information attached? YES___NO___
Lender hereby certifies that the above information is true and correct, to the best of its knowledge, and that it has exercised due diligence to obtain the true and correct information. Lender is aware and acknowledges that SBA review of this form is a quick look at eligibility intended to provide limited protection to SBA and the lender from making an ineligible loan on which SBA could not honor its guarantee and that if an SBA loan number is assigned and SBA later learns that the loan is not eligible, SBA still may deny liability on its guarantee.
Lender Signature: __________________________________________________ Date______________
Typed Name and Title: ____________________________________________
The estimated burden for completing this form is 15 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 3245-0355. PLEASE DO NOT SEND FORMS TO OMB.
| File Type | application/msword |
| File Title | ELIGIBILITY INFORMATION REQUIRED FOR SBAEXPRESS SUBMISSION |
| Author | Michele |
| Last Modified By | CBRich |
| File Modified | 2009-04-08 |
| File Created | 2009-04-08 |