SBA FORM 2276 PART Gulf Opportunity Pilot Loan Progam (GO Loan Pilot)

OMB Approval No.: 3245-0355 Expiration Date:

GULF OPPORTUNITY PILOT LOAN PROGRAM

(GO LOAN PILOT) GUARANTY REQUEST

TO: Sacramento Loan Processing Center

Small Business Administration

6501 Sylvan Rd, Suite 111

Citrus Heights, CA 95610-5017

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: Lender__________________________________________________________________

Contact_________________________________________________________________

Address_________________________________________________________________

Phone____________________________FAX__________________________________

The following items are enclosed:

[ ] 1. Copy of “Supplemental Information for Gulf Opportunity Pilot Loan Program (Part B)”

[ ] 2. Original or facsimile of “Eligibility Information Required for Gulf Opportunity Pilot Loan Program Submission (Part C)”

I approve this application to SBA subject to the terms and conditions stated in this and the attached documents. Without the participation of SBA, to the extent applied for, we would not be willing to make this loan on these terms, and in our opinion the financial assistance approved is not otherwise available on reasonable terms. I certify that none of the Lender’s Associates, including but not limited to its employees, officers, directors, or substantial stockholders (more than 10%) has a financial interest in the Applicant. I approve and certify that the Applicant is a small business according to the standards in 13 CFR Section 121, the loan 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:

_____________________________________________ _______________________

(Signature) Date

_____________________________________________

(Print Name and Title)

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 3245-0355. PLEASE DO NOT SEND FORMS TO OMB.

SBA Form 2276 (Part A) (10-10)