Sba Form 34 Bank Identification Form

OMB Approval No.: 3245‑0081

Expiration Date: 12-31-2011

Office of Investment

Investment Division

Small Business Administration

Instructions for Bank Identification Form (SBA Form 34)

(Funding Net Proceeds)

The Small Business Administration has made arrangements to have the proceeds of the funding of SBA-Guaranteed SBIC leverage disbursed to SBICs by wire transfer of funds to the bank accounts of the SBICs. This procedure will minimize the time lag between receipt of the proceeds of the funding and the availability of the net proceeds to the SBICs.

An SBIC's account may or may not be with a MEMBER BANK OF THE FEDERAL RESERVE SYSTEM ("MEMBER BANK"). If an SBIC's account is with a MEMBER BANK, the SBA or its agent will wire the net proceeds of the funding directly to the SBIC's bank for credit to the SBIC's bank account.

If the SBIC's account is not with a MEMBER BANK, the non-member bank or other financial institution where the funds are to be deposited must have a correspondent or affiliated bank that is a MEMBER BANK. In this case, the SBA or its agent will wire the net proceeds of the funding to the correspondent or affiliated MEMBER BANK which will then credit the SBIC's bank or financial institution for further credit to the SBIC's account.

To receive funds, each SBIC must furnish the requested information, and have an authorized official sign and date the attached form.

Please answer the question on the attached form and provide the information required.

CAUTION: Failure to provide any part of this information, or the filing of inaccurate information may delay your receipt of funds or prevent SBA or its agents from including your leverage request in the funding.

PLEASE NOTE: The estimated burden for completing this form is 20 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3^rd 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. OMB Approval (3245-0081). Do not Send Forms to OMB.

SBA Form 34 (Revised 6-99) (Instructions)

BANK IDENTIFICATION FORM

FOR

DISBURSEMENT OF LICENSEE'S AMOUNT OF NET PROCEEDS

ANSWER THE FOLLOWING QUESTION AND READ THE INSTRUCTIONS BEFORE COMPLETING THE INFORMATION REQUIRED BELOW.

Is your account with a bank that is a MEMBER OF THE FEDERAL RESERVE SYSTEM (MEMBER BANK)?

(Check one) [ ] YES [ ] NO

If the answer to the above question is YES, complete only Section I below.

If the answer to the above question is NO, complete both Sections I & II below.

SBIC BANK IDENTIFICATION INFORMATION

Section I -- MEMBER BANK (INCLUDING CORRESPONDENT OR AFFILIATED MEMBER BANK):

Bank Account Number:

ABA Number:

Name of Bank:

Street Address:

City: State Zip

Section II -- NON-MEMBER BANK OR OTHER FINANCIAL INSTITUTION:

Bank Account Number:

Name of Bank or Other:

Financial Institution

Additional Information (if needed):

Street Address:

City State Zip

By:

(Name of SBIC)

(Authorized Signature) (Date)

SBA Form 34 (Revised 6-99)