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

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OMB Approval No. 3245-0016

SUMBMIT COMPLETED APPLICATIONS TO LENDERS OF CHOICE
SBA Loan Number

U.S. SMALL BUSINESS ADMINISTRATION

Expiration Date: 08/31/2009
Loan Submitted As:

Reg 7(a)

LENDER'S APPLICATION FOR GUARANTY
OR PARTICIPATION

CLP

Business Name of Applicant

Applicant NAICS
Code:

Name of Lender

Telephone (Inc. A/C)

FIRS No. (SBA's Use)

Street Address

City

State

PLP

ZIP

WE PROPOSE TO THE FOLLOWING LOAN TERMS:
Lender's Share

SBA's Share
%

Guaranteed Loan

Term of Loan
%

Years

Payment Beginning

Amount of Loan
$

Monthly Payment
$

Months from Date of Note

Lender's Interest Rate

If Interest Rate is to be Variable

% Per Annum

Base Rate

Adjustment Period

Base Rate Source

Spread

CONDITIONS OF LENDER (e.g. Insurance requirements, standbys, other conditions. Use additional sheet(s))

I approve this application to SBA subject to the terms and conditions outlined above. 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%) have a financial interest in the applicant.
Lender Official (Please Type or Print Name under Signature)

Title

Date

ON PLP SUBMISSIONS ONLY: I approve and certify that the applicant is a small business according to the
standards in 13 CFR 121, the loans proceeds will be used for an eligible purpose, and the owners and managers
of the applicant business are of good character.
Approving/Certifying Lender Official (Please Type or Print Name under Signature)

Title

Date

FOR SBA USE ONLY
Loan Officer's Recommendations

Signature

Approve

Decline

Title

Date

Approve

Decline

Title

Date

Other Recommendation if Required

Signature

State
Reason(s)

State
Reason(s)

THIS BLOCK TO BE COMPLETED BY SBA OFFICIAL TAKING FINAL ACTION
Approve

Decline

State
Reason(s)

Signature

SBA FORM 4-I (2-05) PREVIOUS EDITIONS OBSOLETE

Title

Date

INSTRUCTIONS: Lender will complete and enclose as part of this application package, all working papers, support material, and agreements requested herein,
specifically including:
1. Balance sheet and ratio analysis - comments on trends, debt to worth,
and current ratio.
2. Lender's analysis of repayment ability.

3. Management skill of the applicant.
4. Collateral offered and lien position, and analysis of collateral adequacy.
5. Lender's credit experience with the applicant. Identify weaknesses.

FINANCIAL SPREAD
In Column 1 please show the most recent balance sheet figures of an existing business or the initial equity investment of a start-up business or the purchase of a
business. Columns 2 and 3 are to reflect adjusting entries, the use of loan proceeds, and loan repayment. Column 4 is to reflect the balance sheet of the
business immediately following loan disbursement. Base the financial analysis on Column 4 figures.
BALANCE SHEET

As of

Fiscal Year Ends
DEBIT

AUDITED

UNAUDITED
PRO FORMA

$

$

$

$

$

$

$

$

$

$

$

$

$
$

$
$

$
$

$
$

$
$
$

$
$
$

$
$
$

$
$
$

CREDIT

Assets
Cash
Accounts Rec.
Inventory
Other
Total Current Assets

Fixed Assets

Other Assets

Total Assets

Liabilities & Net Worth

Accounts Payable

Notes Payable

Taxes

Other

SBA

Total Current Liabilities
Notes Payable

SBA

Other

Total Liabilities
Net Worth
Total Liab. & Net Worth
Profit & Loss
Sales

Depreciation

Income Taxes

W/D Officer Comp.

Net Profit after Tax/Deprec.

PRIOR THREE YEARS

$

$

$

$

$
$
$
PRO FORMA SCHEDULE OF FIXED OBLIGATIONS
YEAR 1

$

INTERIM

$

YEAR 2

$

PROJECTIONS

$

$

$

$

YEAR 3

$

YEAR 4

$

Lender's Analysis:

The estimated burden for completing this form is 2 hours per response. You will not be required to respond to collection of information unless it displays a
currently vaild OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W.
Washington, D.C. 20416 and Desk Office for Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202,
Washington, D.C. 30503. OMB Approval (3245-0016) PLEASE DO NOT SEND FORMS TO OMB.

SBA FORM 4-I (2-05)

PREVIOUS EDITIONS OBSOLETE