Form SBA FORM 1920 PART SBA FORM 1920 PART SUPPLEMENTAL INFORMATION FOR SBA EXPRESS-PILOT LOAN PROG

S

OMB Control No.: 3245-0348

Expiration Date: 12/31/2007

MB Approval No.: 3245-0348

Effective Date: 02/19/2004

Expiration Date: 02/28/2007

upplemental Information for SBA Express, Pilot Loan Programs and PLP Processing

SBA Express (Revolving: Yes No) Community Express (Revolving: YesNo) Patriot Express (Revolving: YesNo)

Export Express ( Revolving: Yes  No ) PLP (IT: Yes No) (EWCP: Yes No)

Borrower Name:

Trade Name (dba):

(if no trade name, enter “NA”)

Borrower Contact:

Mr

Ms

First

MI

Last

Borrower Street:

Borrower Zip Code:

Borrower Phone #:

Borrower SSN #:

(must include SSN # for principal of borrower)

#

Employer ID #:

(if available)

Borrower State:

(2 letter abbreviation)

Borrower County:

Borrower City:

Lender Name:

Lender ID #:

Loan Maturity:

(in months)

Loan Amount:

$

SBA Guaranty %:

%

Construction Amount:

$

New Construction?

Variable Interest Rate?

Variable Interest Rate: P+

%

Initial Bank Interest Rate:

%

Exporter?

Yes

No

If yes, amount in export sales applicant has projected loan will support

$

New Business
Outstanding SBA Loan
New Loan is Collateralized

Rural

or

Urban

NAICS Code:

Number of Employees:

Number of Jobs Created:

Number of Jobs Retained:

Franchise?

Franchiser’s Name:

SBA USE ONLY:

Sole Proprietorship?

Partnership?

Corporation?

Other?

Veteran**		1=Non-Veteran; 2=Veteran-Other; 3=Service-Disabled Veteran; 4=Not Disclosed.
Patriot Express*		Codes on next page. Each eligible owner must be identified with one of these codes.
Gender**		M=Male; F=Female; N=Not Disclosed
Race**		1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native Hawaiian or Pacific Islander; 5=White; X=Not Disclosed
Ethnicity**		H=Hispanic or Latino; N=Not Hispanic or Latino; Y=Not Disclosed
Owner #	% Owned *		Veteran	Patriot Exp.*	Gender	Race	Ethnicity	Please reference the above to complete this table for each 20% or greater owner of the primary business associated with the borrower. More than one race may be selected.

Were any other SBA loans with maturities of more than 12 months made to the borrower in the last 90 days? If so, please complete for each loan	SBA Loan #	SBA	Loan	SBA	Term
		Approval Date	Amount	Guaranty %	(in months)

SBA Form 1920SX (Part B) (Revised 1/08) Page 1 of 2

Supplemental Information for SBA Express, Pilot Loan Programs and PLP Processing

Borrower Name:

Use of Loan Proceeds	Amount
Purchase Land only	$
Purchase Land and Improvements	$
Purchase Improvements only	$
Construct a Building	$
Add an Addition to an Existing Building	$
Make Renovations to an Existing Building	$
Pay Off Interim Construction Loan	$
Pay Off Lender’s Interim Loan	$
Leasehold Improvements	$
Purchase Equipment	$
Purchase Furniture and Fixtures	$
Purchase Inventory	$
Pay Trade or Accounts Payable	$
Pay Notes Payable – not Same Institution Debt	$
Pay Notes Payable – Same Institution Debt	$
Purchase Business – Asset Purchase	$
Purchase Business – Stock Purchase	$
Refinance SBA Loan	$
Working Capital	$
SBA Guaranty Fee	$
Other	$
Total	$

*Eligibility Categories for Patriot Express loans only (Mandatory for eligibility purposes):

2=Veteran other than service-disabled (dishonorably discharged not eligible)

3=Service-disabled Veteran

5=Active Duty military eligible for the Transition Assistance Program

6=Reservist or National Guard member

7=Current spouse of any of the four groups listed above; or current spouse of any Active Duty military

8=Widowed spouse of a service member or veteran who died of a service-connected disability

For Patriot Express loans, Patriot Express eligible owners must equal at least 51 percent of the total ownership in the “Owner” block on Page 1.

** The gender/race/ethnicity/veteran data (except as described for Patriot Express) is collected for statistical purposes only. Disclosure is voluntary and has no bearing on the credit decision.

Lender Contact:

Mr

Ms

First

MI

Last

Lender Contact Phone #:

Lender Contact Fax #:

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing the form is 30 minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., SW, Washington DC 20416. PLEASE DO NOT SEND FORMS TO THIS ADDRESS.

SBA Form 1920SX (Part B) (Revised 1/08) Page 2 of 2