SBA Form 2234 Part Supplemental Information for PCLP Processing

OMB Approval No.: 3245-0346
Expiration Date: 02/28/2013

Supplemental Information for PCLP Processing

[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).]

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

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; 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 estimated burden for completing this form is 25 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, Room 10202, Washington, DC 20503. OMB Control Number 3245-0346. PLEASE DO NOT SEND FORMS TO OMB.

SBA Form 2234 (Part B) (2-13) Previous Editions Obsolete Page 2 of 2