SBA FORM 4-I Lender's Application for Guaranty or Participation

U.S. SMALL BUSINESS ADMINISTRATION APPLICATION FOR LOWDOC LOAN OMB Approval No. 3245-0016
Please Print Legibly or Type (ALL BLANKS MUST BE COMPLETED), Use “N/A,” if Blank is Not Applicable)
Expiration Date: 11/30/2004
Nature of Business ____________________________
Business Name _______________________________________________________________
____________________________________________
Trade Name (if different) _______________________________________________________
Date Business Established ______________________
Type: Proprietorship G Partnership G Corporation G LLC G Other G Specify ________
Date Current Ownership Established ______________
Address (Physical Location)____________________________________________________
Number of employees _________________________
City
State
County
Zip ___________
Number of affiliate(s) employees _________________
Mailing Address (if different from above)____________________________________________
Total number of employees after Loan _____________
City
State
County
Zip ___________
Exporter? Yes G No G Pre-Qual? Yes G No G
Phone
IRS Tax ID #___________________________
Franchise? Yes G No G Name _________________
Business Bank ________________________________ Checking Balance $_______________

A. APPLICANT

B. LOAN REQUEST
Maturity:

Amount $

Purpose:________________________________________________________________________________________

How much do you owe? $ _______________
Have you employed anyone to prepare this application? Yes G No G If Yes, how much was paid? $
i
Name of Packager________________________________________________________ Packager’s Tax ID No. or Social Security No. ___________________________
i
Please see “STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDERS” (attached) for Privacy Act rights.
C. INDEBTEDNESS: Furnish information on ALL BUSINESS debts, contracts, notes and mortgages payable. Indicate by an (*) items to be paid with loan proceeds.
To Whom Payable
Purpose
Orig. Date
Cur. Balance
Int. Rate
Maturity Date
Pmt. Amt.
Pmt Frequency
Collateral
Status

D. PRINCIPALS & GUARANTORS: Submit individual Section “D” for each (including anyone who was a principal within the last six months).
D1 Full Name _________________________________Phone _______________ Social Security Number i ____________ Title _____________ Percentage Owned ____%
City
__
State _
Zip____________
Address
__
____________
___
Date of Birth _____________ Place of Birth (City, ST or Foreign Country) _______________________ U.S. Citizen? Yes G No G If No, provide verified INS G-845
D2* Race:

American Indian / Alaska Native

G

Black / African-American

G

Asian

G

Native Hawaiian/Pacific Islander

G

White

Ethnicity: Hispanic./Latino G Not Hispanic./Latino G Gender: Female G Male G
Veteran : Non-Veteran G Veteran G Service Disabled Veteran
*This data is collected for statistical purposes only. It has no bearing on the credit decision. Disclosure is voluntary. One or more boxes for race may be selected.
D3 PERSONAL FINANCIAL STATEMENT: Complete for all guarantors and principals.
Liquid Assets $
___ __ Ownership in Business $ _____
Liabilities Real Estate $
____
Liabilities Other $ ____

Real Estate $ ___
Total Liabilities $ ____

Annual Business Salary $

Source _____

__ Other Repayment Income $

___

G
G

Assets Other $____________ Total Assets $____________
Net Worth (less value of business) $________________
Residence: Own G Rent G Other G Mthly Housing $_________

D4 CURRENT and PREVIOUS SBA (including commitments) and OTHER GOVERNMENT FINANCING: Report debts of all owners, principals and affiliates if they
have ever: 1) requested Government Financing or 2) had a prior loan which resulted in a loss to government (if loss exists, state dollar amount).
Borrower Name

Name of Agency

Loan No.

Date

Original Amount

Balance

Status

Amt of Loss to Government

D5 ELIGIBILITY AND DISCLOSURES (THESE QUESTIONS MUST BE COMPLETED. Mark “Yes” box or “No” box as appropriate.):
I.
Are you or your business involved in any pending lawsuits? Yes G No G If Yes, provide the details as Exhibit A.
II.
Do you or your spouse or any member of your household, or anyone who owns, manages, or directs your business or their spouses or members of their households work
for the Small Business Administration, Small Business Advisory Council, SCORE or ACE, any Federal Agency, or the participating lender? Yes G No G If Yes,
please provide the name and address of the person and the office where employed. Label this Exhibit B.
III. Affiliates: Do you or the applicant business have any interest in any other business as owner, principal, partner or manager? Yes G No G If Yes, provide details to
Lender. Details must include business’ total number of employees (including part-time) and average annual sales for past 3 year.
IV. Are you: (a) presently under indictment, on parole or probation, Yes G No G or (b) have ever been charged with or arrested for any criminal offense other than a minor
motor vehicle violation (including offenses which have been dismissed, discharged, or nolle prosequi) Yes G No G or (c) convicted, placed on pretrial diversion, or
placed on any form of probation including adjudication withheld pending probation for any criminal offense other than a minor motor vehicle violation? Yes G No G
Cleared for Processing: Date________________By_________________________________ Fingerprints Waived: Date________________By________________________

For SBA Use Only
V. I have received and read “STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDER.”
If you knowingly make a false statement or overvalue a security to obtain a guaranteed loan from SBA you can be fined up to $10,000 and/or imprisoned for not more
than five years under 18 U.S.C.1001; if submitted to a Federally insured institution, under 18 USC 1014 by Imprisonment of not more than twenty years and/or a fine
of not more than $1,000,000. I authorize the SBA’s Office of Inspector General to request criminal record information about me from criminal justice agencies for the
purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.
VI. Signature_______________________________________________________
Date_______________________

E. SIGNATURE
I authorize SBA/Lender to make inquires as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I agree that if SBA approves this
loan application I will not, for at least two years, hire as an employee or consultant anyone that was employed by the SBA during the one-year period prior to the disbursement
of the loan. And, I hereby certify that: (1) as consideration for any Management, Technical, and Business Development Assistance that may be provided, I waive all claims
against SBA and its consultants, and (2) all information contained in this document and any attachments is true and correct to the best of my knowledge,
Date _________________________________________
Print Name
Signature

Title _________________________________________

If Corporation, Attested By: ____________________________________________________________
Signature of Corporate Secretary
SBA Form 4-L (8-02) Previous Editions are Obsolete
SUBMIT COMPLETED APPLICATION TO LENDER OF CHOICE
This form was electronically produced by Elite Federal Forms, Inc.

LENDER’S APPLICATION FOR GUARANTY
Please Print Legibly or Type (ALL BLANKS MUST BE COMPLETED), Use “N/A,” if Blank is Not Applicable)
F. ELIGIBILITY EVALUATION: If you have any questions after reviewing SOP 50-10, Appendix 5, contact LowDoc Processing Center about eligibility
issues before submitting an application.
Eligibility Evaluation: To the best of your ability, Have you determined that the Borrower meets SBA eligibility requirements as outlined in SOP 50-10, Appendix 5 and
“Eligibility Checklist,” which the lender must complete?” Yes G No G (Please note, by law, SBA cannot guarantee ineligible loans.)
I approve this application subject to SBA’s approval and subject to the terms and conditions outlined in Section H of this application. Without the participation of SBA to the
extent applied for we would not be willing to make this loan, and in our opinion the financial assistance applied for is not otherwise available on reasonable terms. I certify that
none of the Lender’s employees, officers, directors, or substantial stockholders (more than 10%) has a financial interest in the applicant. I also certify that our institution has an
executed SBA Form 750, “Loan Guaranty Agreement,” and has at least 20 qualified commercial loans [13 CFR §120.410(e)] outstanding demonstrating our significant
experience lending to small business concerns.
Lender Officer (Print Name) _______________________Signature:

Title

Date___________

G. LENDER
Name of Lender (Financial Institution)
Lender’s Street Address

Phone
City

Applicant Business Name ___________________________________

Fax ___________________
State
Zip ________

Applicant NAICS Code__________

Eligible Passive Concern Yes G No G

H. LOAN TERMS: The following section should be completed exactly as shown in SOP 50-10, Appendix 5.
% Loan Amount
No. of Mos. to Maturity
Payments: $
P & I G P + I G No. of Mos. Int. Only
_
SBA Guaranty
Initial Interest Rate: Fixed ____% G Variable ____% G Initial spread over WSJ Prime
% Adjustment Period: Mthly G Qtrly G Other G ___ __
Life Ins. required? Yes G No G On Whom? ______________ Amt $__ _____ Stand-by Agreements? Yes G No G Creditor ________ Amts $_ ____
If Start-Up or Purchasing of Existing Business, Amount of Applicant Injection *:Cash $_______ Assets $_________ Stand-by Debt $________ Other$_______
*Equity in home is not considered injection. If injection is in the form of assets, provide a breakdown of assets in Lender’s Comments (section “J”).

Use of Proceeds:

Collateral:

Market

Amount

Type

Value

Purpose

Description (Include R.E. address)

Existing Lien(s)
Lien holder

Balance

Liquidation
Value

Acquire/Renovate Real Property
Acquire Fixed Assets, Non-RE
Inventory
Working Capital
Refinance SBA Debt “Not Eligible”
Refinance Non-SBA Debt
Purchase Existing Business
Other: ________________
Total (Must equal Loan Amount)

TOTAL

* Lender must retain copies of refinanced notes. Debt refinancing must not exceed 25% of total loan amount if it is the participant lender’s debt.

I. FINANCIAL STATEMENTS [Do not use ATTACHMENTS]: (Balance Sheet and Current Income Statement must be of the same period)
BALANCE SHEET
Pro Forma G
Interim G
ASSETS
Cash Equivalent

Year End

G

INCOME STATEMENT
(As of
LIABILITIES

)

Notes Payable

No. of Interim Mos. _____

Current

Projected

a) Net Sales/Revenue

Net Trade Rec.

Trade Payable

b) Cost of Sales

Inventory

Current LTD

c) Gross Profit

Other Curr.

Other Curr. Liab.

d) Owner Comp/Drawings

Total Curr.

Total Curr. Liab.

e) Rent

Net Fixed Assets

Long Term Debt

f)

Other Assets

Other Liabilities

g) LongTerm Debt Int. Exp.

Intangible Assets

Standby Debt (Principal Only)

h) General & Other Exp.

Total Assets

Total Liabilities

Tangible Net Worth
Total Annual Standby Debt (P&I) ________________________

Prior FY

Date:

Depreciation / Amort.

i)

Net Income (c less d – h)

A

Cash Flow (f+g+i)

B) Term Debt P & I
Debt Coverage Ratio (A / B)

J. LENDERS COMMENTS: (Comment on Management’s character, and the business’ financial strength and repayment ability, including forecast.)
Business Start-Ups and Purchases: Lender MUST comment on management qualifications, location, competitive factors and feasibility of business plan. [One additional
page for comments may be submitted, if necessary]

SBA Form 4-L (8-02) Previous Editions are Obsolete