SBA Form 2234 Part PCLP Guarantee Request

OMB Approval No.: 3245-0346
Expiration Date: 12/31/2009

PCLP Guarantee Request

TO: Sacramento Loan Processing Center DATE: ______________________

Small Business Administration

U.S. Federal Courthouse

501 I Street, Suite 12-100

Sacramento, CA 95814-2322

RE: Applicant Name _______________________________________________________

Operating Company (OC) Name (If applicant is an Eligible Passive Company)__________________________

____________________________________________________________________

(If more than one OC, attach additional sheet with all OC names)

FROM: CDC ___________________________________________________________

Contact ___________________________________________________________

Address ___________________________________________________________

___________________________________________________________

Phone ___________________________ FAX _________________________

All of the following items are enclosed:

[ ] A. Copy of pages 2 and 7 of SBA Form 1244 (02-02), “Application for Section 504 Loan”

[ ] B. Copy of "Supplemental Information for PCLP Processing" (Part B)

[ ] C. Original or facsimile of "Eligibility Information Required for PCLP Submission" (Part C)

____________________________________ _____________________

Signature and Title of CDC Date

The estimated burden for completing this form is 5 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 3245-0346. PLEASE DO NOT SEND FORMS TO OMB.

The PCLP CDC completes this form as part of the application package for Section 504 Loan and sends to: Sacramento Loan Processing Center, Small Business Administration, 6501 Sylvan Road, Suite 111, Citrus Heights, CA. 95610-5017 (or Fax to 916 735 0640).

SBA Form 2234 (Part A) (6-09) Previous Editions Obsolete