Form SBA Form 1244 SBA Form 1244 Application For Section 504 Loans

U.S. SMALL BUSINESS ADMINISTRATION
APPLICATION FOR SECTION 504 LOANS

OMB APPROVAL NO.: 3245-0071
EXPIRATION DATE: xx/xx/xxxx

This form and exhibits are to be completed by the loan applicant and the Certified Development Company (CDC). The
information is used to review the small business loan applicant’s eligibility, its indebtedness, creditworthiness, and certain
other disclosures. SBA also uses the information to assess the CDC’s request for guarantee of the debenture. The loan
applicant submits the requested information to the CDC. The CDC will forward the information to SBA:
SBA Sacramento Loan Processing Center at 6501 Sylvan Road, Suite 111, Citrus Heights CA 95610-5017.

PART A
Name of CDC:
CDC Contact Person:
Name of Borrower:

Telephone No:

Name of Small Business Concern (SBC) (if different):
THE FOLLOWING EXHIBITS MUST BE SUBMITTED: [Indicate if Attached (X) or Not Applicable (N/A).]
Instructions: If the CDC is using the Abridged Submission Method (ASM), the CDC must collect and retain in its file, but not submit to SBA, each Exhibit
Check if ASM Submission
Check if Debt Refinancing Loan Application With Expansion
marked with an asterisk (*).
Check if Debt Refinancing Loan Application Without Expansion
1.

A credit memorandum, which includes CDC's credit analysis, a history and
description of the business and analysis of management ability, and
description of the qualifications and background of the principals involved
in day-to-day management of the business. Exhibit 1.

12.* The names of affiliated (through ownership or management control) or
subsidiary businesses as well as the last two fiscal year-end financial
statements and/or federal income tax returns for the last two years (or
three years, if the alternate 7(a) size standard is being used). Exhibit 12.

2.

"Eligibility Information Required for 504 Submission" form. Exhibit 2 (SBA
Form 2450).

13.

3.

If a “yes” answer is provided to Questions 1, 2, 3, 5, or 6 in section II.B.
below, Personal History Statement (SBA Form 912) for each officer and
director (regardless of ownership), key employee and each proprietor,
partner and stockholder with 20% or more ownership of the small business
concern (SBC) and, if different, each owner with 20% or more ownership of
the EPC. Exhibit 3.

If the business is a franchise and not listed on the franchise registry,
include a copy of the Franchise Agreement and the Franchisor's
Disclosure Statement that is required by the Federal Trade Commission. If
this business is on the franchise registry, provide Certification of
Franchise documents. Exhibit 13.

14.

A copy of key cost documents such as contractor costs, estimates, vendor
quotes for machinery and equipment, etc. as well as an itemized listing of
estimated "professional fees" that is summarized in Part B, Section VII.
Exhibit 14. Full or partially executed purchase/sale agreements must be
provided.

15.

An independent appraisal for project real estate as required by SOP 50-10.
Exhibit 15.

16.

Environmental analysis, if applicable. Exhibit 16.

17.

A letter of intent/term sheet from the participating lender stating the terms
and conditions of its participation and the reason why it will not finance
the entire project. Exhibit 17.

18.

USCIS verification of the USCIS status of any alien who is an owner of
20% or more of the small business applicant or any person who controls
(as defined by SBA regulations and policies) the small business applicant.
Exhibit 18.

4. * Personal Financial Statement (SBA Form 413) current within 90 days for
each proprietor, partner or stockholder with 20% or more ownership of the
SBC, and, if different, each owner with 20% or more ownership of the EPC,
as well as copies of federal income tax returns for the last one year. Exhibit
4.
5.

{Reserved}. Exhibit 5.

6. * A balance sheet and income statement as well as federal income tax returns
for the previous two years for the SBC (or three years, if the alternate 7(a)
size standard is being used). If the SBC is a new business, provide a
proforma balance sheet with a description of assumptions attached.
Exhibit 6.
7. * A balance sheet and income statement dated within 120 days of the
application together with an aging of the accounts receivable and accounts
payable listed. Exhibit 7.
8. * Where appropriate, a projected, annualized income statement for the first
two years after the loan with a description of assumptions attached.
Exhibit 8.
9. * For a new business, a monthly cashflow analysis for the first 12 months of
operation or for three months beyond the breakeven point (whichever is
longer) together with a description of assumptions attached. Exhibit 9.
10.* A schedule of debts which includes the original date and amount, monthly
payment, interest rate, present balance owed, maturity, to whom payable,
and collateral securing the loan for each short-term and long-term loan that
the business currently has outstanding or has planned for the next 12 months
(other than the 504 loan). Please indicate whether each loan is current or
delinquent. Exhibit 10.
11.* A schedule of any previous government financing received by the applicant
small business concern or any affiliated company of the applicant as well as
any associate (as defined by §120.10) or principal of the applicant. Include
the name of the agency, the original date and amount, the outstanding
balance, status of the loan (current, delinquent, paid in full, or charged off),
and collateral securing the loan. Exhibit 11.

SBA Form 1244 (09-16) Previous editions obsolete

19.* Credit reports for the SBC, its owner(s), and affiliates who are guarantors.
Credit reports are not required for non-guarantor affiliates. Exhibit 19.
20.* A completed SBA Form 159 (504) (Fee Disclosure Form and
Compensation Agreement) for costs incurred by the applicant to third
parties (attorney, accountant, etc.). Exhibit 20. (Submit to CDC at loan
closing.)
21.

Copies of most current debt and lien instruments (for Expansion
Refinance), and transcript of account or equivalent for any debts being
refinanced and certifications required for refinancing.

22. Credit Alert Verification Reporting System (CAIVRS) report to document
applicant, guarantors and affiliates do not have a Prior Loss to the
Government or Delinquent Federal Debt.

Page 1 of 13

U.S. SMALL BUSINESS ADMINISTRATION
APPLICATION FOR SECTION 504 LOAN
PART B
I.

Certified Development Company

Date of Application

Contact Person

Telephone No.

IIA. Borrower's Name

Employer ID Number

Name of Small Business Concern (SBC) if other than Borrower

EPC

Name of Principal in charge of the SBC

Telephone No.

SBC's Address

Street Address of Project (if different)

City

County

State/Zip Code

City of Project

County of Project

Yes:

No:

State/Zip Code

II.B ALL QUESTIONS MUST BE ANSWERED AND ARE SUBJECT TO VERIFICATION BY SBA.

1. Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal
criminal charges are brought in any jurisdiction?
Yes  No 
2. Have you been arrested in the past six months for any criminal offense?

Yes  No 

3. For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) plead guilty;
3) plead nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation
(including probation before judgment)?
Yes  No 
4. Has an application for the loan you are applying for now ever been submitted to SBA or to a Certified Development
Company or lender in connection with any SBA program?
Yes  No 
5. Are you presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency?
Yes  No 
6. If you are at least a 50% or more owner of the applicant business, are you more than 60 days delinquent on any
obligation to pay child support arising under an administrative order, court order, repayment agreement between the
holder and a custodial parent, or repayment agreement between the holder and a state agency providing
child support enforcement services?
Yes  No 
If “YES” to Question 1, the loan request is ineligible for SBA assistance.
If “YES” to Question 2 or 3, you must complete SBA Form 912 and furnish details on a separate sheet, including dates, location,
fines, sentences, whether misdemeanor or felony, dates of parole/probation, unpaid fines or penalties, name(s) under which
charged, and any other pertinent information.
If “YES” to Questions 2 or 3, the lender will be required to conduct a background check and make a character determination in
accordance with the procedures described in SOP 50 10 5.
If “YES” to Question 3 and you are currently on parole or probation (including probation before judgment), the loan request is
ineligible for SBA assistance. If the charge resulting in a “YES” was a single misdemeanor that was subsequently dropped
without prosecution, you must provide documentation from the appropriate court or prosecutor’s office along with the
completed Form 912.
If “YES” to Questions 4, 5 or 6, the SBA Form 912 must be completed and submitted to the Sacramento Loan Processing Center
(SLPC) for processing.
SBA Form 1244 (09-16) Previous editions obsolete

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III.

Corp., Yrs Chartered

Location

Check appropriate description
Existing Business

Partnership, No. Partners
Proprietorship

Relocation

LLC

Type of Business

1 - Urban
2 - Rural

New Business

NAICS Code Date Established

Yes
Minority Code

No

Check if applicable:
Woman-owned
Veteran-owned
Service Disabled Veteran-owned

IV. A. Name(s) of Participating Lender(s)

Amount:

Contact Person

Telephone No.

B. Name of Other Sources (including any other Federal sources)

Amount:

C. Name of Interim Lender (if different from IV.A.)

Amount:

Contact Person

Telephone No.

V. Please explain the purpose and Economic Impact of the Project

SBA USE ONLY

Approved by D.O.

SBA Form 1244 (09-16) Previous editions obsolete

Date

Funding Approved

Date

Page 3 of 13

VI.

A. Impact on Jobs

B. CDC's overall portfolio job ratio as of the date of the last
Annual Report
C. Economic Development Objectives

1. Pre-project Employment
2. Number of jobs to be created in the next
two years
3. Number of jobs to be retained because of
project

Community or Area Development
Public Policy Goals (check one or more below)***

4. Total jobs to be created and retained (2 + 3)

Business district revitalization

5. Debenture Amt./$65,000
(504 projects only)

Expansion of exports
Minority-owned business
Enhanced economic competition
Changes necessitated by Federal
budget cutbacks

Yes
No
Yes

6. Does Project meet job requirement of 1 job
per $65,000?
7. If small manufacturing, does Project meet
job requirement of 1 job per $100,000?

VII.

Proposed Uses of Funds
A. Land (and purchase of existing
building, if applicable):
B. Building (new construction,
remodeling, L/H improvement, etc.):
C. Machinery & equipment (purchase,
installation, etc.):

IX.

$
$

$

production

______ Reduces unemployment
in labor surplus areas

Requested
%) of Project Cost

$

G. TOTAL PROJECT COST (Not
including 504-related fees)

$

$

2. Funding Fee (Ax0.0025)

$

3. CDC Processing Fee (Ax_____%)

$

4.Closing Costs

$

5. Total (B1 through B4)

$

6. Underwriters Fee*

$

7. Total (B5 plus B6)

$

C. Total Debenture Amount (A plus B7, rounded up to
$

D. Balance to Borrower (C minus (A + B7)

$
$

Dollar Request

% Project Cost

A. Net Debenture (VIII.A.)
Gross Debenture (VIII.C.)

$

1. SBA Guarantee Fee (Ax______%)

next thousand)

F. Other Expenses (eligible business
expenses, construction contingency,
interest on interim financing, etc.):

Sources of Funds (504 projects only)

_____ Renewable energy

B. Administrative Costs

$

E. Professional fees (appraiser, architect,
legal, etc.):

_____ Sustainable building design

VIII. Debenture Pricing (504)
A. SBA Share (

$

_____ Reduce energy use by 10%

Business restructuring from Federally mandated policies affecting the
environment, employee safety or health.
Veteran-owned business
Woman-owned business

No

Amount Requested

D. Debt to be refinanced

Energy Efficiency Goals

Rural development

XXX

Maturity

Interest Rate

Lien Position

XXX

XXX

XXX

XXX

XXX

B. Private Sector

C. Other Financing (specify)

D. Borrower Injection
E. CDC Injection
F. TOTAL PROJECT FINANCING**
X.

100.00%

XXX

XXX

XXX

Source of Equity Injection

*

Underwriters fee calculated as follows: For 20 year Debentures, the sum of a. and b.5 divided by 0.99600; round this number up the next highest
thousand; multiply this number by 0.00400. For 10 year Debentures, the sum of a. and b.5 divided by 0.99625; round this number up to the next highest
thousand; multiply this number by 0.00375.
** This does not include 504-related fees and costs.
***The public policy goals refer to the public policy goals referenced in section 501(d)(3)(A) through (K) of the Small Business Investment Act. Applicants
are eligible for a higher debenture if they can show the project achieves an applicable energy public policy or small manufacturing goal.

SBA Form 1244 (09-16) Previous editions obsolete

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XI.

Financial Summary
Fiscal Year Ending

Statements (check one):

BALANCE SHEET

Audited

AS OF

Review

ADJUSTMENTS
Debits

Credits

Compilation

ADJ/FINANCIAL DATA
(Pro Forma)

ASSETS
Cash
Accounts Receivable
Inventory
Other
Total Current Assets
Fixed Assets
Other Assets
Total Assets
LIABILITIES & NET WORTH
Accounts Payable
Notes Payable
Taxes/Accruals
** Private Lender (cur. Portion)
SBA (current portion)
Other
Total Current Liabilities
Notes Payable
Private Lender (L-T portion)
SBA (L-T portion)
Other
Total Liabilities
Net Worth
Total Liabilities & Net Worth
Ratio Analysis (use pro forma column)
*

XII.

NAICS Code

SBC

Industry Averages

SBC Use Only

Debt/Net Worth Ratio
Net Working Capital
Current Ratio
Other:
XIII. Balance Sheet Comments/Adjustments (e.g. goodwill, intangibles, etc.)
[Include here, or in credit memorandum (SBA Form 1244, Exhibit 1).]

*Notes Payable: include any existing current portion of long-term debt.
**For lender's share of 504 project only.

SBA Form 1244 (09-16) Previous editions obsolete

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XIV.

Income
Statement

Historical
Year

Historical
%

Current Interim

Year

%

Projection
%

%

Sales
Cost of Goods Sold
Gross Profit
G&A Expenses
Net before Taxes
Income Taxes
Net after Taxes
Break out of specific expenses: included in G + A above:
Depreciation
Interest
W/D& Officer Comp
Rent

XV.

Cash Flow Available for P&I

Existing

Projection

Year:

A. Earnings Before Taxes
B. + Depreciation
C. + Interest Expense
D. + Rent Savings, if any
E. + Other
1.
2.
F. Total Cash Flow
G. Existing Debt Service (P + I)
H. + Project Debt Service (P + I)
I. + Line of credit - principal
J. + Line of credit - Interest
K. + Other
L. Total Cash Requirements (G - K)
M. Cash Margin (F minus L)

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

Year:

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

N. Cash Flow Coverage Ratio
(F divided by L)
XVI.

Comments on Ability to Repay - (Include Working Capital Analysis and comments on credit history.)
[Include here, or in credit memorandum (SBA Form 1244, Exhibit 1).]

SBA Form 1244 (09-16) Previous editions obsolete

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XVII. List of Project Collateral

Cost or Net Book Value

Senior Lien

Appraised Value

(if available)

Land (and/or purchase of existing building)
Building (new construction, remodeling,
leasehold improvements, etc.)
Machinery and equipment (purchase,
installation, etc.)

Totals
Guarantor(s) and/or Owners

Personal Net Worth

Pledged Security (if applicable)

Analysis of Collateral Adequacy. (Include summary of environmental analysis, if any.)
[Include here, or credit memorandum (SBA Form 1244, Exhibit 1).]

XVIII. CDC Notifications
Has any member, officer, director or professional staff of CDC changed since last debenture request?
If so, has Form 1081 and resume been submitted to SBA?

SBA Form 1244 (09-16) Previous editions obsolete

Yes:

No:

Yes:

No:

Page 7 of 13

XIX. CDC and Borrower Agreements and Certifications
A. CDC Agreements and Certifications
The CDC agrees that if SBA approves this application, it will not for at least
two years after the disbursement of the debenture hire an employee or
consult anyone who was employed by the SBA during the one-year period
prior to the disbursement of the debenture.
The CDC certifies that it does not own any stock or equity in the SBC and no
officer, director, or person within a controlling group of the CDC is an
officer, director or holder of any direct or indirect pecuniary interest in the
SBC.
The CDC authorizes disclosure of all information submitted in connection
with this application to the financial institution agreeing to participate with
the SBA's guaranteed debenture or loan.
The CDC certifies that it will comply with 13 C.F.R. Sections 112, 113, and
117 which prohibit discrimination on the grounds of race, color, sex,
religion, marital status, handicap, age or national origin by recipients of
Federal financing assistance; and will require appropriate reports and access
to books and records. These requirements are also applicable to anyone who
buys or takes control of the business. He/she realizes that if he/she does not
comply with these nondiscrimination requirements, SBA can call, terminate,
or accelerate repayment on his/her loan.
As consideration for any Management and Technical Assistance that may be
provided, the CDC waives all claims against SBA and its consultants.
The CDC certifies that it has not paid anyone connected with the Federal
government for help in getting this financial assistance. It also agrees to
report to the SBA Office of Inspector General, 409 3rd Str., SW, Washington,
D.C. 20416 any Federal government employee who offers in return for any
type of compensation to help get this application approved.
The CDC understands that it need not pay anyone to deal with SBA. He/she
has read SBA Form 159 which explains SBA policy on representatives and
fees.
The CDC states, to the best of its knowledge and belief, that if any funds
have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of a Member of Congress in connection
with this commitment providing for the United States to insure or guarantee a
loan, it shall complete and submit Standard Form-LL, "Disclosure Form to
Report Lobbying," in accordance with this instructions. Submission of this
statement is a prerequisite for making or entering into this transaction
imposed by 31 U.S.C. 1352. Anyone who fails to file the required statement
shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
The CDC in consideration for assistance from SBA hereby agrees that it will
comply with all Federal laws and regulations enforced to the extent that they
are applicable to such assistance, including conditions set forth in this
application.
The undersigned certifies that all information in this application and the
exhibits is true and complete to the best of his/her knowledge and is
submitted to SBA so that the CDC and SBA can decide whether to approve
this application.
The CDC acknowledges that submission of false information to SBA, or the
withholding of material information from SBA, can result in criminal

prosecution under 18 U.S.C. 1001 and other provisions, liability for treble
damages under the False Claims Act, 31 U.S.C. 3729-3733, debarment and
suspension, lender enforcement remedies under 13 C.F.R. Part 120, and other
consequences.
The CDC certifies that the credit analysis has been reviewed and approved by
the CDC Board of Directors.
B. Borrower Agreements and Certifications
I agree that if SBA approves this application, I will not for at least two years
hire an employee or consult anyone who was employed by the SBA during
the one year period prior to the disbursement of the debenture.
______________________________________________________________
I certify: I have not paid anyone connected with the Federal government for
help getting this financial assistance. I also agree to report to the SBA Office
of Inspector General, 409 Third Street S.W., Washington, D.C. 20416, any
Federal government employee who offers in return for any type of
compensation to help get this application approved. I understand that I need
not pay anybody to deal with SBA. I also understand that a Certified
Development Company may charge the applicant a percentage of the loan
proceeds as set forth in SBA regulations as a fee for preparing and processing
the loan applications. I agree to pay for or reimburse SBA for the cost of any
surveys, title or mortgage examinations, appraisals, etc., performed by nonSBA personnel provided that I have given my consent.
Regulations issued by SBA prohibit the making of loans to relocate any
operations of a small business which will cause a net reduction of one-third
or more in the workforce of the relocating small business or a substantial
increase in unemployment in any area of the country.
In the event that proceeds from this loan are used to provide a facility for
relocation of the beneficiary small business concern (including any affiliate,
subsidiary or other business entity under direct, indirect or common control),
the undersigned certifies that such relocation will not significantly increase
unemployment in the area of the original location.
No overlapping relationship exists between the small business concern,
including its associates, and the CDC, including its associates, or any other
lender providing financing for the project that could create an appearance of
a conflict of interest as defined in 13 CFR 120.140 or violate 13 CFR
120.851. No such relationships existed within six months of this application
or will be permitted to exist while assistance is outstanding.
I authorize disclosure of all information submitted in connection with this
application to the financial institution agreeing to participate with SBA's
guaranteed debenture. I waive all claims against SBA and its consultants for
any management and technical assistance that may be provided. In
consideration for assistance from the Small Business Administration, I
hereby agree that I will comply with all Federal laws and regulations to the
extent that they are applicable to such assistance, including conditions set
forth in this application. I, my spouse, or any member of my household, or
anyone who owns, manages, or directs the business or their spouses or
members of their households do not work for the SBA, Small Business
Advisory Council, SCORE or ACE, any Federal agency, or the participating
lender. If someone does, the name and address of such person and where
employed is provided on an attached page.

Name of Development Company:

By:

Title:

Date:

Attested By:
PLEASE NOTE: The estimated burden for completing this form and exhibits is 2.25 hours per application for ASM submissions and 2.45 for non-ASM
submissions. You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. Comments or
questions on the burden estimate should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416 and/or SBA
Desk Officer, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.
PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 1244 (09-16) Previous editions obsolete

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U.S. SMALL BUSINESS ADMINISTRATION
PART C
Statements Required by Law and Executive Order
Federal executive agencies, including the Small Business Administration (SBA), are required to withhold or limit financial assistance, to
impose special conditions on approved loans, to provide special notices to applicants or borrowers and to require special reports and data
from borrowers in order to comply with legislation passed by the Congress and Executive Orders issued by the President and by the
provisions of various inter-agency agreements. SBA has issued regulations and procedures that implement these laws and executive orders,
and they are contained in Parts 112, 113, 116, and 117, Title 13, Code of Federal Regulations Chapter 1, or Standard Operating Procedures.
Freedom of Information Act (5 U.S.C. 552)
This law provides, with some exceptions, that SBA must supply information reflected in agency files and records to a person requesting it.
Information about approved loans that will be automatically released includes, among other things, statistics on our loan programs (individual
borrowers are not identified in the statistics) and other information such as the names of the borrowers (and their officers, directors,
stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms and the maturity.
Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be addressed to the
nearest SBA office and be identified as a Freedom of Information request.
Privacy Act (5 U.S.C. 552a)
A person can request to see or get copies of any personal information that SBA has in his or her file when that file is retrieved by individual
identifiers such as name or social security numbers. Requests for information about another party may be denied unless SBA has the written
permission of the individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of
Information Act.
Under the provisions of the Privacy Act, you are not required to provide your social security number. But see Debt Collection notice below.
Disclosures of name and other personal identifiers are, required for a benefit, as SBA requires an individual seeking assistance from SBA to
provide it with sufficient information for it to make a character determination. In determining whether an individual is of good character,
SBA considers the person’s integrity, candor, and disposition toward criminal actions. In making loans pursuant to section 7(a)(6) of the
Small Business Act (the Act), 15 USC Section 636(a)(6), SBA is required to have reasonable assurance that the loan is of sound value and
will be repaid or that it is in the best interest of the Government to grant the assistance requested. Additionally, SBA is specifically
authorized to verify your criminal history, or lack thereof, pursuant to section 7(a)(1)(B), 15 USC Section 636(a)(1)(B). Further, for all forms
of assistance, SBA is authorized to make all investigations necessary to ensure that a person has not engaged in acts that violate or will
violate the Act or the Small Business Investment Act, 15 USC Sections 634(b)(11) and 687(b)(a). For these purposes, you are asked to
voluntarily provide your social security number to assist SBA in making a character determination and to distinguish you from other
individuals with the same or similar name or other personal identifier.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use for SBA’s loan
system of records is that when this information indicates a violation or potential violation of law, whether civil, criminal, or administrative in
nature, SBA 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 of personal information 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, SBA-21, Loan System, at 74 FR 14890 (April
1, 2009) as amended by notices published at 77 FR 15835 (3/16/2012) and 77 FR 61467 (10/9/2012) for additional background and
other routine uses.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401)
This is notice to you as required by the Right of Financial Privacy Act of 1978, of SBA's access rights to financial records held by financial
institutions that are or have been doing business with you or your business, including any financial institutions participating in a loan or loan
guarantee. The law provides that SBA shall have a right of access to your financial records in connection with its consideration or
administration of assistance to you in the form of a Government loan or loan guaranty agreement. SBA is required to provide a certificate of
its compliance with the Act to a financial institution in connection with its first request for access to your financial records, after which no
further certification is required for subsequent accesses. The law also provides that SBA's access rights continue for the term of any approved
loan or loan guaranty agreement. No further notice to you of SBA's access rights is required during the term of any such agreement.
The law also authorizes SBA to transfer to another Government authority any financial records included in an application for a loan, or
concerning an approved loan or loan guarantee, as necessary to process, service or foreclose on a loan or loan guarantee or to collect on a
defaulted loan or loan guarantee. No other transfer of your financial records to another Government authority will be permitted by SBA
except as required or permitted by law.

SBA Form 1244 (09-16) Previous editions obsolete

Page 9 of 13

Debt Collection Act of 1982 Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles)
These laws require SBA to aggressively collect any loan payments which become delinquent. SBA must obtain your taxpayer identification
number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may take one or more of the
following actions:
- Report the status of your loan(s) to credit bureaus
- Hire a collection agency to collect your loan
- Offset your income tax refund or other amounts due to you from the Federal Government
- Suspend or debar you or your company from doing business with the Federal Government
- Refer your loan to the Department of Justice or other attorneys for litigation
- Foreclose on collateral or take other action permitted in the loan instruments
Flood Disaster Protection Act (42 U.S.C. 4011)
Regulations have been issued by the Federal Insurance Administration (FIA) and by SBA implementing this Act and its amendments. These
regulations prohibit SBA from making certain loans in an FIA designated floodplain unless Federal flood insurance is purchased as a
condition of the loan. Failure to maintain the required level of flood insurance makes the applicant ineligible for any future financial
assistance from SBA under any program, including disaster assistance.
Executive Orders -- Floodplain Management and Wetland Protection (42 F.R. 26951 and 42 F.R. 26961)
The SBA discourages any settlement in or development of a floodplain or a wetland. This statement is to notify all SBA loan applicants that
such actions are hazardous to both life and property and should be avoided. The additional cost of flood preventive construction must be
considered in addition to the possible loss of all assets and investments in future floods.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.)
This legislation authorizes the Occupational Safety and Health Administration in the Department of Labor to require businesses to modify
facilities and procedures to protect employees or pay penalty fees. In some instances, the business can be forced to cease operations or be
prevented from starting operations in a new facility. Therefore, in some instances SBA may require additional information from an applicant
to determine whether the business will be in compliance with OSHA regulations and allowed to operate its facility after the loan is approved
and disbursed. Signing this form as borrower is a certification that the OSA requirements that apply to the borrower's business have been
determined and the borrower to the best of its knowledge is in compliance.
Civil Rights Legislation
All businesses receiving SBA financial assistance must agree not to discriminate in any business practice, including employment practices
and services to the public, on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of SBA Regulations. This includes making
their goods and services available to handicapped clients or customers. All business borrowers will be required to display the "Equal
Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691)
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color,
religion, national origin, sex, marital status or age (provided that the applicant has the capacity to enter into a binding contract); because all or
part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the
Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.
Executive Order 11738 -- Environmental Protection (38 C.F.R. 25161)
The Executive Order charges SBA with administering its loan programs in a manner that will result in effective enforcement of the Clean Air
Act, the Federal Water Pollution Act and other environmental protection legislation. SBA must, therefore, impose conditions on some loans.
By acknowledging receipt of this form and presenting the application, the principals of all small businesses borrowing $100,000 or more in
direct funds stipulate to the following:
1.

That any facility used, or to be used, by the subject firm is not cited on the EPA list of Violating Facilities.

2.

That subject firm will comply with all the requirements of Section 114 of the Clean Air Act (42 U.S.C. 7414) and Section 308 of the
Water Act (33 U.S.C 1318) relating to inspection, monitoring, entry, reports and information, as well as all other requirements specified
in Section 114 and Section 308 of the respective Acts, and all regulations and guidelines issued thereunder.

3.

That subject firm will notify SBA of the receipt of any communication from the Director of the Environmental Protection Agency
indicating that a facility utilized, or to be utilized, by subject firm is under consideration to be listed on the EPA List of Violating
Facilities.
.

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Immigration and Nationality Act (8 U.S.C. 1101, et seq., as amended)
If you are an alien who was in this country illegally since before January 1, 1982, you may have been granted lawful temporary resident
status by the United States Citizenship and Immigration Services pursuant to the Immigration Reform and Control Act of 1986 (Pub. L. 99603). For five years from the date you are granted such status, you are not eligible for financial assistance from the SBA in the form of a loan
or guaranty under section 7(a) of the Small Business Act unless you are disabled or a Cuban or Haitian entrant. When you sign this document,
you are making the certification that the Immigration Reform and Control Act of 1986 does not apply to you, or if it does apply, more than
five years have elapsed since you have been granted lawful temporary resident status pursuant to such 1986 legislation.
Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4821 et seq.)
Borrowers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using lead-based paint (as
defined in SBA regulations) on all interior surfaces, whether accessible or not, and exterior surfaces, such as stairs, decks, porches, railings,
windows and doors, which are readily accessible to children under 7 years of age. A "residential structure" is any home, apartment, hotel,
motel, orphanage, boarding school, dormitory, day care center, extended care facility, college or other school housing, hospital, group
practice or community facility and all other residential or institutional structures where persons reside.

Executive Order 12549 as amended by E.O. 12689, Debarment and Suspension and 2 CFR Part 2700
1.

The prospective lower tier participant certifies, by submission of this loan application, that neither it nor its principals are presently
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department or agency.

2.

Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective
participants shall attach an explanation to the loan application.

Applicant Notifications
The Applicants, its proprietors, partners, officers or stockholders owning 20% or more of the Applicant
have/
have not
been involved in bankruptcy or insolvency proceedings. This question covers not only the Applicant, but also the personal bankruptcy or
insolvency proceedings of proprietors, partners, officers or stockholders owning 20% or more of the Applicant. You must attach copies
of the proceedings, if any.
The Applicant, its proprietors, partners, officers or stockholders owning 20% of more the Applicant
are/
are not
involved in any pending lawsuits. This question covers not only the Applicant, but also proprietors, partners, officers or
stockholders owning 20% or more of the Applicant in their personal capacities.

Applicant's Acknowledgment
My signature acknowledges receipt of these Statements Required by Laws and Executive Orders, that I have read it and that I have a copy for
my files. My signature represents my agreement to comply with the requirements SBA makes in connection with the approval of my loan
request and to comply, whenever applicable, with the limitations contained in these Statements.
Certification as to Application Accuracy – Criminal Penalties for False Statements
The undersigned certifies that all information provided to the CDC, and that all information in, and submitted with this application, including
all exhibits is true and complete to the best of his or her knowledge. Applicant acknowledges that the application and exhibits are submitted
to the CDC and to SBA so that the CDC and SBA can decide whether to approve this application. Any future submissions of information to
the CDC must be accompanied by a certification as to the accuracy of that information.
The undersigned acknowledges that whoever makes any false statement or report, or willfully overvalues any land property or security for the
purpose of influencing in any way the action of the SBA under the Small Business Investment Act, as amended, may be punished by a fine of
not more than $1,000,000 or by imprisonment for up to 30 years, or both, pursuant to 18 U.S.C. 1014. The undersigned further acknowledges
that, in connection with a 504 loan, submission of any false statement to the CDC or SBA or submission of any record to the CDC or SBA
omitting material information can result in civil money penalties and additional monetary liability up to three times the amount of damages
which the Government sustains because of the false statement under the False Claims Act, 31 U.S.C. 3729.

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(Each Proprietor, each General Partner, each Limited Partner or Stockholder owning 20% or more, and each Guarantor must sign. Each
person should only sign once.)
If Applicant is a proprietor or partnership, sign below:

If Applicant is an L.L.C. or corporation, sign below:

Name of Business

Corporate Name

By:

Date:

By:

Attested by:

Date:

(seal, if required)

Additional Proprietors, Partners, Stockholders or Guarantors as required.

Signature

Date

Signature

Date

Signature

Date

Signature

Date

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U.S. SMALL BUSINESS ADMINISTRATION
APPLICATION FOR SECTION 504 LOAN
________________________________________________________________________
PART D
Instructions for Third Party Lender Certification for Loans Made For Debt Refinancing
________________________________________________________________________________________________________________________________________________

The Third Party Lender must provide the following certifications in its commitment letter submitted as Exhibit 17
of SBA Form 1244, Application for Section 504 Loan.
The Third Party Lender certifies that it has no reason to believe that the following statements are not true:
1.

Either:
(a.) Substantially all (85% or more) of the proceeds of the indebtedness being refinanced were used to acquire and Eligible Fixed
Asset (e.g. land, including a building situated thereon, to construct a building thereon, or to purchase equipment) and the
remaining amount (15% or less) was incurred for the benefit of the small business seeking the refinancing; or
(b) If the Eligible Fixed Asset(s) was (were) originally financed through a commercial loan (the “original loan”) that was
subsequently refinanced one or more times:
(i) substantially all (85% or more) of the proceeds of the original loan was used to acquire an Eligible Fixed Asset (e.g.,
land, including a building situated thereon, to construct a building thereon, or to purchase equipment) and the
remaining (15% or less) was incurred for the small business seeking the refinancing; and
(ii) the existing debt is the most recent refinancing of the original loan.

2.

All of the proceeds of the indebtedness being refinanced were used for the benefit of the small business.

3.

For Same Institution Debt:
OPTION A - For Debt Refinancing with Expansion
If the indebtedness being refinanced is debt of the Third Party Lender, or any of its affiliates, (Same Institution Debt), the
Third Party Lender must certify that it is not in a position to sustain a loss causing a shift to SBA of all or part of a potential
loss from the existing debt.

OPTION B – For Debt Refinancing Without Expansion
If the indebtedness being refinanced is debt of the Third Party Lender, or any of its affiliates, (Same Institution Debt), the
Third Party Lender must certify that it is not in a position to sustain a loss on the Refinancing Project amount causing a shift to
SBA of all or part of a potential loss from the existing debt.

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