Form SBA FORM 1502R SBA FORM 1502R Lender Disbursment Collections Report for SBA Guaranteed

O MB Control Number 3245:3245-0368

Expiration Date : 5/31/2010

LENDER DISBURSEMENT/COLLECTION REPORT

FOR SBA GUARANTEED REVOLVING LINES OF CREDIT

Lenders shall complete this Form for specific lines of credit, when directed by SBA, in order to provide SBA with a synopsis of the monthly disbursement and collection (loan payments and fees) activity for that line of credit. This Form shall be submitted, as directed by SBA, to SBA on a quarterly basis. Monthly activity shall be from the first to the last business day of each month.

FOR THE PERIOD BEGINNING: and ENDING:

mm/dd/yyyy mm/dd/yyyy

SBA LOAN NAME:

SBA LOAN NUMBER:

LENDER’S NAME:

Summary for the Period Covered By This Report:

FOR THE MONTHS OF

TOTAL NUMBER OF DISBURSEMENTS:

TOTAL AMOUNT DISBURSED:

TOTAL NUMBER OF PAYMENTS:

TOTAL AMOUNT OF PAYMENTS:

DOLLAR AMOUNT TO INTEREST:

DOLLAR AMOUNT TO PRINCIPAL:

ADDITIONAL CURTAILMENT DOLLARS:

HIGHEST PRINCIPAL BALANCE:

MONTH END BALANCE:

FEES CHARGED:

FEES COLLECTED:

Signature of Lender Required with Each Report:

I certify that all information on this form is true and accurate to the best of my knowledge. I understand that false information can be subject to the criminal penalties set forth in 18 U.S.C. § 1001.

Lender Official: Date:

Signature:

The total estimated time to respond to this form, including time to read instructions, and compile the information needed to respond, is 20 minutes. You are not required to respond to this 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, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

SBA Form 1502 R (06/10)