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pdfEXPORT-IMPORT BANK Application for Global Credit Express
of the UNITED STATES
REVOLVING LINE OF CREDIT
PART A. PRINCIPAL PARTIES
OMB No. 3048-0038
Expires 08/31/2012
This application is to be used for export financing of up to $500,000 for terms of 6 or 12 months.
1. Borrower/ Exporter
Company Name
Telephone No.
Web Site
Tax ID Number
D&B Number
Name of Contact Person
Title of Contact Person
Telephone No.(e.g.,(202)565-3946)
Email Address (if applicable)
Address (No P.O. Boxes)
City
State
Zip
Alabama
No. of Full-Time Employees:
Is the majority ownership of your
business represented by:
Gross Sales - Last FYE:
women
Primary North American Industrial “Small Business Concern” as
Classification System (NAICS) No.: described in SBA Guidelines:
Does your firm have at least 3
minority years of revenue producing
Yes
No
Yes
No
operations and at least 1 year of
exporting experience?
2 . Borrower’s Management (Proprietors, partners, officers, directors and holders of all outstanding stock or other ownership
interests -100% of ownership must be shown.) Attach separate sheet of paper if necessary.
Last Name (owner #1)
First Name
Title/Management Position
Social Security Number
Address (No P.O. Boxes)
City
State
% Owned | Guarantor
Alabama
Yes
Country
Postal Code
Last Name (owner #2)
First Name
Title/Management Position
Social Security Number
Address (No P.O. Boxes)
City
State
% Owned | Guarantor
Alabama
Country
EIB 11-08 (01/12)
Yes
No
No
Postal Code
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OMB No. 3048-0038
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Last Name (owner #3)
First Name
Title/Management Position
Social Security Number
Address (No P.O. Boxes)
City
State
% Owned | Guarantor
Country
No
Yes
Alabama
Postal Code
3 . Borrower’s Affiliate(s) where Affiliate is defined as any firm closely related to the Borrower through common ownership by a parent
company or any company where the Borrower directly or indirectly owns 5% or more of the company's voting stock. [If more than
one Affiliate, please attach a separate list of all other Affiliates to include the information outlined below.]
Company Name
Address (No P.O. Boxes)
City
D&B Number
Tax ID Number
State
Country
Alabama
Postal Code
4 . Description of Export Business Practices
Approximate number of foreign
accounts
Number of years exporting
Do you currently have an export
credit insurance policy
Yes
What payment terms do you currently provide to your foreign buyers?
Open Account - Credit
Letter of Credit
Cash in Advance
Other
Total Export Credit sales losses for prior 3 years
If yes, carrier
No
Total Export Credit sales for prior 3 years
90+ days overdue Export Credit Sales
Export Credit AR Outstanding
Weighted Average Export Credit
Terms >90 days
Yes
No
List Your Five Largest Export Sales Markets
Country
Projected Export Volume
Shipping to Country Less than 12 months
Country
Projected Export Volume
Shipping to Country Less than 12 months
Country
Projected Export Volume
Shipping to Country Less than 12 months
Country
Projected Export Volume
Shipping to Country Less than 12 months
Country
Projected Export Volume
Shipping to Country Less than 12 months
EIB 11-08 (01/12)
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OMB No. 3048-0038
Expires 08/31/2012
5. Description of Principal Line of Business and Products / Goods / Services to be exported
6. Description of how this loan will benefit your export related business
7. Calculation of Maximum Loan Amount and U.S. Content in Export Related Goods and Services
Check one set of Direct and/or Indirect Terms of Sale to be used as the basis for calculating the Maximum Loan Amount
Purchase Contracts/Orders
Invoiced Last Fiscal Year
Invoiced Preceding 12 Months
Direct Export Sales
Direct Export Sales
Direct Export Sales
Indirect Export Sales
Indirect Export Sales
Indirect Export Sales
1. Direct Exports with greater
than 50% U.S. Content
The price of individual goods and services identified in the Export Contracts
or Invoices that have greater then 50% U.S. Content based on all costs,
exclusive of profit, for the reporting period.
2. Direct Exports with 50% or
less U.S. Content
The cost of individual goods and services identified in the Export Contracts or
Invoices that have 50% or less U.S. Content based on all costs, exclusive of
profit, for the reporting period. Multiply the aggregate cost of these items by
the US Content percentage of these goods and services for the reporting
period. If an amount is entered in this block, complete Section 8 of this
Application
3. Indirect Exports with greater
than 50% U.S. Content
The price of individual goods and services that have greater than 50% US
Content based on all costs, exclusive of profit, sold to US based companies
provided that (a) the ultimate buyer or end user must be located in a foreign
country and (b) the Borrower must obtain from the US based company
verifiable evidence of their intent to export or proof that the goods or services
have been exported from the United States for the reporting period.
4. Indirect Exports with 50% or
less U.S. Content
The cost of individual goods and services that have 50% or less US Content
based on all costs, exclusive of profit, sold to US based companies provided
that (a) the ultimate buyer or end user must be located in a foreign country
and (b) the Borrower must obtain from the US based company verifiable
evidence of their intent to export or proof that the goods or services have
been exported from the United States. Multiply the aggregate cost of these
items by the US Content percentage of these goods and services for the
reporting period. If an amount is entered in this block, complete Section 8 of
this Application
5. Eligible Exports
The sum of the US Content in boxes 1, 2, 3 and 4 above.
6. Excluded Country Sales
Sales to countries where Ex-Im Bank Support for Private Sector is not
available for transactions less than one year. See Ex-Im Bank Country
Limitation Schedule.
7. Ineligible Export Sales
Export Sales to Military Buyers, Capital Goods and Services facilitating
Additions to Global Raw Steel or DRAM Semiconductor Making Capacity.
8. Net Eligible Export Sales
Line 5 less Lines 6 and 7.
9. Net Current Assets
Sum of Current Assets less Short-Term Secured Debt Obligations.
Use most recent financial statement provided as a basis for this calculation.
10. Maximum Loan Amount
The lesser of: 50% of line 8, or 90% of line 9, or $500,000.
11. Requested Loan Amount
12. Requested Loan Term
Enter 6 or 12 months.
Ex-Im Bank Content Policy URL: www.exim.gov/pub/ins/pdf/eib99-21.pdf
Ex-Im Bank Country Limitation Schedule URL: www.exim.gov/tools/country/country_limits.cfm
EIB 11-08 (01/12)
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OMB No. 3048-0038
Expires 08/31/2012
8. Goods and Services that have 50% or less U.S. Content
Complete this section only if an amount was entered in blocks 2 or 4 of Section 7.
Description of Good or Service
Including NAICS
EIB 11-08 (01/12)
Description of Foreign Content
Country of Origin
U.S. Costs ($)
Total Costs ($)
Page 4 of 7
PART B. CERTIFICATIONS AND NOTICES
OMB No. 3048-0038
Expires 08/31/2012
The Applicant (hereafter “Applicant” or “it”) CERTIFIES, ACKNOWLEDGES and COVENANTS to the Export-Import Bank of the United States (hereafter “ExIm Bank”) that to the best of Applicant's knowledge and belief, after due diligence, the statements set forth below are true and correct. Any reference below to
“this transaction” shall refer to either the individual transaction or the Ex-Im Bank program or Insurance Policy that is the subject of the application, as appropriate.
A.
Neither Applicant, nor any of its Principals (as defined in the Debarment Regulations identified below), has, within the past 3 years, been:
1) debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in a Covered Transaction (as
defined in Government-wide debarment regulations, found at 2 CFR Part 3513 and 2 CFR Part 180, respectively) (collectively the
“Debarment Regulations”);
2) formally proposed for debarment from participating in a Covered Transaction, with a final determination still pending;
3) indicted, convicted or had a civil judgment rendered against it for any conduct or offenses described at 2 CFR § 180.800 in the
Debarment Regulations;
4) had a public transaction (whether Federal, State or local) terminated for cause or for default:
5) been delinquent on any non-tax debt due and owing to the U.5. Government or its agencies or instrumentalities as of the date of
execution of this certification; or
6) listed on any of the publicly available debarment lists of the following international financial institutions: the World Bank
Group; the African Development Bank; the Asian Development Bank; the European Bank for Reconstruction and Development, and the
Inter-American Development Bank; or the Applicant has received a written statement of exception from Ex-1m Bank attached to this
certification, permitting acceptance of this application notwithstanding an inability to make all of the certifications in clausesl) through 6) of
this section A.
B.
Applicant has conducted and will conduct reasonable due diligence in connection with this transaction, including checking the Excluded
Parties List System (http://www.epls.gov/epls/search.do) (“EPLS”) and the Specially Designated Nationals (“SDN”) List of the Department
of the Treasury, Office of Foreign Assets Control (“OFAC”) (http://www.ustreas.gov/offices/enforcement/ofac/sdn/). Applicant has not and
will not knowingly enter into any sales, leasing or financing agreements in connection with this transaction with any individual or entity that
is listed on the EPLS or the SDN List (or is otherwise prohibited from conducting business with U.S. public and private entities pursuant to
OFAC Regulations).
C.
Either: (1)To the best of Applicant's knowledge and belief, no funds have been paid or will be paid to any person in connection with this
application for influencing or attempting to influence:
(a) an officer or employee of any U.S. Government agency, or
(b) a Member of Congress or a Member's employee, or
(c) an officer or employee of Congress;
(This does not apply to commissions paid by the Bank to insurance brokers.)
or (2) Applicant will complete and submit Form-LLL (the Anti-Lobbying Declaration/Disclosure forms available at http://www.exim.gov/
pub/ins/pdf/lll.pdf )
D.
Neither Applicant nor any agent or representative acting on Applicant's behalf, has or will engage in any activity in connection with this
transaction that is a violation of: 1) the Foreign Corrupt Practices Act of 1977, 15 U.S.C. § 78dd-1, et seq.; (the violation of which can
result in civil and/or criminal penalties against companies and individuals); 2) the Arms Export Control Act, 22 U.S.C.§ 2751 et seq., 3)
the International Emergency Economic Powers Act, 50 U.S.C. § 1701 et seq.; 4) the Export Administration Act of 1979,50 U.S.C. § 2401
et seq., and, 5) the regulations issued by the OFAC. Applicant also certifies that neither Applicant nor any agent or representative acting
on Applicant's behalf, has been found by a court of the United States to be in violation of any of the foregoing statutes or regulations
within the preceding 12 months, and to the best of its knowledge, the performance by the parties to this transaction of their respective
obligations does not violate any of the foregoing or any other applicable law.
E.
Neither the Applicant nor any agent or representative acting on Applicant's behalf in connection with this transaction is currently under
charge or has been, within the past 5 years, convicted in any court of any country, or subject to national administrative measures of any
country, for bribery of public officials.
F.
Applicant covenants and declares that it will. upon demand. disclose to Ex-1m Bank: 1) the identity of companies and individuals acting
on Applicant's behalf in connection with the transaction: and, 2) the amount and purpose of commissions and fees paid, or agreed to be
paid to such persons.
G.
The representations made and the facts stated in this application and its attachments are true Applicant has not misrepresented or
omitted any material facts. Applicant further covenants that if any statement(s) set forth in this application becomes untrue, or is
discovered to have been untrue when made, Applicant will promptly inform Ex-Im Bank of such change. Applicant further understands
that in accepting or approving this application, Ex-Im Bank a is relying upon Applicant's statements set forth in the application and on the
foregoing certifications, and all statements and certifications are subject to the penalties for false or misleading statements to the U.S.
Government (18 USC § 1001, et. seq.).
H.
Authorization - I authorized Ex-Im Bank to make inquiries as necessary to verify the accuracy of the statements made and to determine
my creditworthiness, including making certain "routine uses" of information protected by the Privacy Act as described below. In
connection with the foregoing, the undersigned authorize Ex-Im Bank to report their credit experience with the Applicant(s) and its
Guarantor(s) to the applicable credit bureaus.
EIB 11-08 (01/12)
Page 5 of 7
OMB No. 3048-0038
Expires 08/31/2012
NOTICES
The Applicant is hereby notified that information requested by this application is done so under authority of the Export-Import Bank Act of 1945,
as amended (12 USC 635 et. seq.); provision of this information is mandatory and failure to provide the requested information may result in ExIm Bank being unable to determine eligibility for support. If any of the information provided in this application changes in any material way or if
any of the certifications made herein become untrue, the Applicant must promptly inform Ex-Im Bank of such changes. The information
provided will be reviewed to determine the participants' ability to perform and pay under the transaction referenced in this application. Ex-Im
Bank may not require the information and Applicants are not required to provide information requested in this application unless a currently
valid OMB control number is displayed on this form (see upper right of each page). Ex-Im Bank reserves the right to decline to process or to
discontinue processing of an application.
PAPERWORK REDUCTION ACT STATEMENT
We estimate that it will take you about 1.5 hours per response that includes the time it will take to read the instructions, gather the necessary
facts and fill out the form. However, you are not required to provide information requested unless a valid OMB control number is displayed on
the form. If you have comments or suggestions regarding the above estimate or ways to simplify this form, forward correspondence to Ex-Im
Bank and the Office of Management and Budget, Paperwork Reduction Project, OMB # 3048-xxxx Washington, D.C. 20503.
PRIVACY ACT NOTICE
Privacy Act Notice - The Applicant is hereby notified that Ex-Im Bank requests the information in this application under the authority of the
Export-Import Bank Act of 1945, as amended (12 U.S.C. 635 et seq.) Providing the requested information is mandatory (but see “Submission
of Social Security Number” notice below). The purpose for which the information is intended to be used is to determine the Applicant's
eligibility for financial assistance under the Global Credit Express program. The Privacy Act authorizes Ex-Im Bank to make certain “routine
uses” of information protected by that Act. One such routine use is that when this information indicates a violation or potential violation of
law, whether civil, criminal, or administrative in nature, Ex-Im Bank may refer it to the appropriate agency, whether Federal, State , local or
foreign, charged with responsibility for or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.
Another routine use is to assist in obtaining credit bureau reports, including business credit reports on the small business borrower and
consumer credit reports and scores on the principals of the small business and guarantors on the loan for purposes of originating, servicing,
and liquidating small business loans and for purposes of routine periodic loan portfolio management and lender monitoring. See __ F.R.
_______ (and any subsequently published notices) for additional background and other routine uses.
Submission of Social Security Number - Under the Privacy Act, the Applicant is not required to provide social security number information,
and failure to provide social security number may not affect any right, benefit, or privilege to which applicant is entitled. Applicants are not
entitled to any right, benefit or privilege under the Ex-Im Bank Global Credit Express program. If the requested information, including the
social security number, is not provided then Ex-Im Bank may not be able to determine the applicant's eligibility for financial assistance
under the Global Credit Express program.
Name of Borrower:
Signature
Date
Name of Guarantor:
Signature
EIB 11-08 (01/12)
Name and Title of Authorized Representative (Print or Type):
Name and Title of Authorized Representative (Print or Type):
Date
Page 6 of 7
OMB No. 3048-0038
Expires 08/31/2012
PART C. To Be Completed by Originating Financial Institution
Originating Financial Institution Name
Name and Title of Contact Person (last, first, middle initial)
Address
City
Telephone No.
(e.g.,(202)565-3946)
State
Zip
Email Address (if applicable)
Fax No.
(e.g.,(202)565-3946)
Alabama
Describe the relationship between the Originating Financial Institution and the Borrower, to include the length and nature of the relationship.
Application Fee Amount
Origination Fee Due
Fico SBSS Score
The minimum score shall not be
lower than 180 (available from ExIm Bank).
Ex-Im Bank Exporter Score
A score less than 40 may result in a
requirement for additional credit
enhancements (available from Ex-Im Bank)
Applicant is not on the Excluded Parties list. (http://www.epls.gov/epls/
search.do) ("EPLS") reviewed
Applicant is not on the Office of Foreign Assets Control list ("OFAC")
(http://www.ustreas.gov/offices/enforcement/ofac/sdn/) reviewed
We would not be willing to make this loan on the terms prescribed in the Global Credit Express Program, and in our opinion the financial assistance to be
approved is not otherwise available on reasonable terms without the participation of Ex-Im Bank.
Name and Title of Authorized Representative (Print or Type)
Signature
Date
CHECKLIST OF INFORMATION TO BE ATTACHED
(Note: All Attachments must be signed and dated by persons signing Parts A & B of this form.)
1.
Tax returns on the Borrower for the previous three years. Exhibit A
2.
Financial Statements [including notes] on the Borrower for the previous three years. Exhibit B
3.
Personal Financial Statement of the principal owner(s) of the business (at least 20% ownership). Exhibit C
4.
5.
Current Receivables Aging. Exhibit D
6.
Evidence of Exports (i.e. copies of export orders or export shipment ledger with contact information) Exhibit F
7.
List of all Liens and Existing Indebtedness Exhibit G
Current Inventory Schedule Exhibit E
PART D. Loan Set-up (internal to Ex-Im Bank)
Initial Loan
Restructure
Renewal
Amendment
Reference Loan Number:
Loan Amount
Final Disbursement Date
Guarantee Period Expiry Date
Interest Payment Schedule
Interest Rate Basis
First Interest Payment Date
Interest Payment Day of Month
Loan Interest Rate
Interest Rate Spread over Rate
Basis
If Interest Rate is Fixed - Rate
FICO SBSS Reference #
Collateral Position
If other Collateral Position, please list below:
EIB 11-08 (01/12)
Page 7 of 7
| File Type | application/pdf |
| File Modified | 2012-03-16 |
| File Created | 2011-09-01 |