SBA FORM 2411 iMMEDIATE Disaster Assistance Program (IDAP) Lender's Ap

OMB Control No.: 3245-0372

Expiration Date: 6/30/2014

MB Approval No.: 3245-0348

Effective Date: 02/19/2004

Expiration Date: 02/28/2007

IMMEDIATE DISASTER ASSISTANCE PROGRAM (IDAP)

Lender’s Application (Part I)

(To be completed and signed by the participating lender that is requesting an SBA guaranty for the loan application and submitted to SBA through http://eweb.sba.gov/gls.)

Disaster Declaration No. ___________________________________

Small Business Direct Disaster Loan Application No. (if known) _________________________________

Small Business Borrower Name (legal name):

Check the legal business structure that applies:

Sole Proprietorship  Partnership  LLC  Corporation

Other: ___________

Trade Name (dba):

(if no trade name, enter “NA”)

Borrower Contact:

Mr

Ms

First

MI

Last

Borrower Street:

Borrower City:

County:

State

Zipcode

Borrower Phone #:

Borrower Tax ID #:

#

SSN# of Principal (controlling owner of borrower)

Loan Amount:

$

Loan Maturity

Initial Period Interest Rate as published in the Federal Register for IDAP Loans

Term Period Interest Rate

Prime rate* + _____________(not to exceed maximum published in the Federal Register) *in effect on the first business day of the month as identified in a national financial newspaper

• Outstanding SBA Loan. If checked, Loan No. ______________________________

NAICS Code:	__________	No. of Employees (on disaster date):	___________
Franchise?	If checked, Franchise Name: ________________________________

Use of Loan Proceeds	Amount (Total Dollars)
Repair/Replace Disaster Damage to Real Property	$
Repair/Replace Disaster Damage to Business Personal Property	$
Working Capital	$
Total	$

Credit Score used (optional) ___________	Select Agency Equifax TransUnion Experian
Application Fee charged to Borrower, if any: _______________________ (Limit: $250)

Lender Name:

Lender ID

Lender Contact:

Mr

Ms

First

MI

Last

Lender Contact Phone #:		Lender Contact Fax #:
Lender E-mail:

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 10 minutes. 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 2411 (05/14) 1