Form SBA Form 2234 Part SBA Form 2234 Part Supplemental Information for PCLP Processeing

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

Supplemental Information for PCLP Processing

Borrower Name:

Trade Name (dba):

(if no trade name, enter “NA”)

Project Street:

Project Zip Code:

Borrower Phone #:

Borrower SSN #:

(must include SSN # for principal of borrower)

Employer ID #:

(if available)

Project State:

(2 letter abbreviation)

Project County:

Project City:

Project located in Special Geographic Area

CDC Name:

CDC ID #:

Debenture Maturity:

(in months)

Net Debenture Amount:	$		Gross Debenture Amount:	$
Borrower Contribution:	$		CC Closing Costs:	$
Not a Recovery Act Application

Exporter?

Yes

No

If yes, export sales amount projected loan will support:

$

New Business?

Outstanding SBA Loan?

Real Estate Collateral

Rural

or

Urban

NAICS Code:

All Applicant’s production facilities are located in the U.S.?

No. of Employees:

No. of Jobs Created:

No. of Jobs Retained:

• CDC’s 504 loan portfolio meets or exceeds CDC’s required Job Opportunity Average

Franchise?

Franchiser’s Name:

Sole Proprietorship?

Partnership?

Corporation?

Other?

3rd Party Loan Amount:

$

3rd Party Lender:

Lender ID #:

3rd Party Street:

3rd Party City:

State:

Zip Code:

• Special-Purpose Asset?

B1 – Community or Area Development	C5 - Restructuring Because of Federally Mandated Standards or Policies
C1 – Business District Revitalization	C6 – Changes Necessitated by Federal Budget Cutbacks
C2 – Expansion of Minority Business Development	C7 - Rural Development
C3 – Enhanced Economic Competition C4 – Expansion of Exports E1 – Reduce Energy Use by 10% E3 – Renewable Energy Production	C8 – Veteran-owned Businesses C9 – Women-owned Businesses E2 – Sustainable Building Design

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

Supplemental Information for PCLP Processing

Borrower Name:

Veteran Status: ** 1= Non-Veteran; 2=Other Vet.; 3=Service-Disabled Vet.; 4=Not Disclosed. 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 Code	Gender Code	Race	Ethnicity	Please reference the above codes to complete this table for each 20% or greater owners of the business. More than one race code may be selected.**Collected for statistical purposes only, disclosure is voluntary and has no bearing on credit decision.

Use of Loan Proceeds	Amount
Purchase Land	$
Purchase Land and Improvements	$
Purchase improvements	$
Construct a Building	$
Add an Addition to a Building	$
Make Renovation to a Building	$
Make Leasehold Improvements to a Building	$
Purchase/Install Equipment	$
Purchase/install Fixtures	$
Pay Outstanding Debt	$
Other Expenses (construction contingencies, interim interest)	$
Professional Fees	$
Total	$

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 B) (6-09) Previous Editions Obsolete Page 2 of 2