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APPLICATION FOR GUARANTEE
INSTRUCTIONS FOR PREPARATION
Purpose:

Lenders use this form to apply for an FSA loan guarantee.

Loan applicants should not submit this form to FSA. This form is submitted to FSA by lenders after the lender has recorded the required information.


Handbook Reference:
2-FLP
Number of Copies: 
Original copy.

Lenders submit the original of the completed form in hard copy, scanned via email or facsimile to the appropriate USDA servicing office. 
Signatures Required:
Applicant, Co-Applicant, Co-Signer, Entity Member, and Lender.
Distribution of Copies:
Original to FSA servicing office. (Documents sent via email or facsimile are considered originals)
Automation-Related Transactions:  GLS


Lenders who have established electronic access credentials with USDA eforms may electronically transmit this form to the USDA servicing office. The application will be processed; however, the original, signed copy (hard, scanned/emailed or facsimile) of the form must be submitted to the local servicing office before FSA can issue a loan guarantee. Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site. If lenders haven’t established electronic access credentials with USDA, they can also submit the application via email or facsimile.

All loan applicants must complete Part A and Parts D through F.  Entity applicants must complete Part B. Individual applicants must complete Part C.  Co-applicants, co-signers, and entity members must complete Parts O and P.  Ethnicity, race, gender, and veteran status information is voluntary. Additional pages for Parts O and P may be attached for additional co-applicants, entity members or co-signers.

Lenders must complete Parts G through M. 


NOTE:  Any questions answered “NO” may require additional information. 
             Lenders should contact the local FSA Office for more direction.

Fld. Name/
Item No.
Instruction
PART A – Type of Operation (Loan Applicant)
1
Type of Operation
Check the appropriate box for the type of operation.  Entity applicants complete Part B.  Individual applicants complete Part C.
PART B – Entity Applicant Information (Loan Applicant)
1
Entity Name
Enter the entity’s name.
2
Entity Address
Enter the entity’s business mailing address.  Include the physical address if different from mailing address.
3
Number of Entity Members
Enter the number of individuals and/or embedded entities who have an ownership interest in the entity.  All members must complete Parts O and P.  (Refer to 2-FLP, paragraph 111 (d) for embedded entity information)
4
Entity Tax ID Number

Enter the entity’s tax ID number.

5
Entity Headquarters County
Enter the county where the entity’s headquarters is located.
6
Entity Telephone Number
Enter the telephone number (Including Area Code) for the entity.
7
Entity Telephone Type
Check the telephone type (Home, Cell, Work) for the entity.
PART C – Individual Applicant Information (Loan Applicant)
1
Applicant’s Full Legal Name
Enter the applicant’s complete legal name.
2
Applicant’s Address
Enter applicant’s complete mailing address, including physical address if different from mailing address.
3
Applicant’s Birthdate
Enter applicant’s date of birth (MM-DD-YYYY).
4
Applicant’s 9 Digit Social Security or Tax ID Number 

Enter applicant’s 9-digit social security number or tax ID number.

5
Residence or Headquarters
Enter county the applicant resides and the county where the headquarters office is located if different from each other. 

6
Applicant’s Telephone Number
Enter applicant’s home or business telephone number, including area code.
7
Applicant Telephone Type
Check the telephone type (Home, Cell, Work) for the applicant.
8
Marital Status
For individual applicants, check the box that most closely corresponds to current marital status.
9
Citizenship Status
Check appropriate box.  If not a U.S. citizen, applicant will be asked to provide I-551 and/ or other proper documentation of immigration status as found under PRWORA (8 U.S.C. 1641)
PART D – Other Information (Loan Applicant)

Note: To be considered a Socially Disadvantaged Applicant, the majority interest must be held by eligible individual(s)
1
Other Business Names
If the individual applicant or entity applicant has conducted business under any other name, answer “YES”.  If not, answer “NO”.

If “YES”, enter the other name(s) the applicant has used.
2A
Ethnicity
Check the appropriate box indicating individual applicant or entity applicant ethnicity.
2B
Race
Check the appropriate box or boxes indicating individual applicant or entity applicant race.
2C
Gender
Check the appropriate box indicating individual applicant or entity applicant gender.
2D
Veteran Status
Check the appropriate box indicating individual applicant or entity applicant veteran status.
PART E – Eligibility Information (Loan Applicant)
1
Description of Operation
Describe the applicant’s operation or proposed operation including the commodity(s) that is or will be produced.
2
Operator of a Family Farm

Check “YES” if the applicant is or will be the operator of a family size farm. If not, check “NO”.

3
Number of Years
Enter number of years individual applicant or entity applicant has operated a farm. If applicant is an entity, number of years farming for each entity member must be input.
4
Acres Owned
Enter total number of acres individual applicant or entity applicant currently owns.
5
Acres Rented
Enter total number of acres individual applicant or entity applicant currently rents.
6
Debt Forgiveness
Check “YES” if you (including all members if an entity) have NOT caused the Agency any loss. If you have, check “NO”.
7
Delinquent Debt to the U.S. Government
Check “YES” if you (including all members if an entity) do NOT have any delinquent debt owed to the US Government.  If you have delinquent debt owed to the US Government, check “NO”.

Debt to the U.S. Government includes but is not limited to education loans, obligations to the Commodity Credit Corporation, Natural Resources Conservation Service, Veterans Administration, FSA, Rural Housing Service or Federal Crop Insurance Corporation/Risk Management Agency.
8
Outstanding Recorded Judgments
Check “YES” if you (including all members if an entity) do NOT have any outstanding judgements obtained by the U.S. in Federal Court. If you do have recorded judgements, check “NO”. 
9
Citizen of the US
Check “YES” if you or the members holding majority interest in the entity are citizens of the U.S., a U.S. non-citizen national, or a qualified alien under applicable Federal immigration laws. If not, check “NO”.
10
Legal Capacity
Check “YES” if you (including all members if an entity) have the legal capacity to incur debt. If not, check “NO”.
11
Controlled Substances
Check “YES” if you (including all members if an entity) have NOT been convicted of planting, cultivating, growing, producing, harvesting, storing, trafficking, or possessing a controlled substance within the last 5 crop years. If you have been convicted, check “NO”.
12
Disqualification due to Crop Insurance violation
Check “YES” if you (including all members of an entity) are NOT ineligible due to disqualification resulting from a Federal Crop Insurance violation according to 7 CFR Part 718.  If you are ineligible for this reason, check “NO”.
13
Employee or Related to an Employee
Check “YES” if you (including all members if an entity) are NOT an employee, related to an employee, or an associate of an employee of the lender or Farm Service Agency. If you are, check “NO”.
14
Sufficient Credit
Check “YES” if you (including all members if an entity) are UNABLE to get credit without a guarantee. If you are able to, check “NO”. 
15
False Statements
Check “YES” if you (including all members if an entity) have NOT given FSA false or misleading documents or statements in the past. If you have, check “NO”.
PART F - Loan Applicant Certifications (Loan Applicant)
Certification/ Acknowledgment
Please read the statements in this section carefully before signing.
1A
Signature of Applicant
Enter the signature of the applicant. 
1B
Capacity
Check “Self” if you are signing for yourself. Check “Entity Representative” if you are signing on behalf of an entity. Check both boxes if applicable.
1C 
Date
Enter the date (MM-DD-YYYY) the applicant signed the form.






PART G - Type of Assistance Requested (All Lender Types)
1
Request Number
Enter number of requests for each guarantee request submitted on FSA-2211. For example: If form FSA-2211 is submitted for Guaranteed FO assistance only, this item should be completed to show “1 of 1” and Parts G, H, and I would be completed only once.

If form FSA-2211 is submitted for Guaranteed FO assistance, Guaranteed OL assistance, and Guaranteed OL-Line of Credit assistance, only Parts G, H, and I must be completed for each guarantee requested. The separate request section should be completed to show “1 of 3", “2 of 3", and “3 of 3”.  
2
Loan Type
Check the appropriate box for the type of loan the applicant is requesting.
3
EZ Guarantee
Check “YES” if the guarantee request is submitted under the EZ Guarantee program.  Check “NO” if the guarantee request is NOT submitted as an EZ Guarantee.
4
Loan Amount or LOC Ceiling
Enter the amount of the loan request or Line-of-Credit (LOC) ceiling.
5
Interest Rate
Enter the rate of interest the loan applicant will be charged and check the appropriate box if the rate is “Fixed” or “Variable”.

Note:  If the interest rate is variable or fixed for less than five years, check Variable.
           If the interest rate is fixed for five or more years, check Fixed.
6
Requested Guarantee Percentage
Check “Maximum” box if requesting that FSA consider the maximum guarantee percentage allowable or choose “Other” and enter the requested guarantee percentage if a guarantee percentage less than the maximum is desired.

7
Repayment Period
Enter the repayment period (years) for the loan requested.  

Note:  For LOC, enter the number of years the loan will be outstanding, not the
           number of years of advances.
8
Principal Repayment Terms
Enter the principal repayment terms for the loan requested, including estimated installment; even, uneven, balloon; and frequency of installment.
9
Interest Repayment Terms
Enter the interest repayment terms for the loan requested, including estimated installment; even, uneven, balloon; and frequency of installment.






PART H – Funds Purpose (All Lender Types)
1
Funds Purpose
Enter purpose for which loan funds obtained under FSA guarantee will be used. 

Example 1:  OL/LOC Request for Guarantee

Annual operating costs for cash grain operations
Annual family living costs




Example 2: OL to refinance ‘authorized’ farming debts

Carry-over operating losses
Machinery and Equipment debts


2
Funds Amount
Enter the amount of money to be used for each purpose.

Example 1:   OL/LOC Request for Guarantee

Annual operating costs for cash grain operations	$30,000
Annual family living costs	                                           $18,000


Example 2: OL Request for Guarantee

Carry-over operating losses	                            $92,000
Machinery and Equipment debts                                  $88,000
PART I - Proposed Security (All Lender Types)
1 - 5
Proposed Security
 
Enter specific security information for each field.

Example 1: 
OL/LOC Request for Guarantee

1.
Item Description
2.
Lien Position
3.
Est. Value
4.
Amount of Prior Lien
5.
Collateral Value

Crops 
Machinery
1st
2nd
$96,000
$82,000
$0
$50,000
$96,000
$32,000

Example 2: 
OL Request for Guarantee

1.
Item Description
2.
Lien Position
3.
Est. Value

4.
Amount of Prior Lien
5.
Collateral Value

Machinery/Equipment
RE  
1st
2nd
$280,000
$82,000
$65,000
$50,000
$215,000
$32,000
6
Totals
Enter totals of column from Items 3, 4 and 5.
PART J – Interest Assistance Documentation (Applicable Only for Interest Assistance Applications)
1 
Net Cash Flow without Interest Assistance
Enter information from the applicant’s cash flow budget. This item should be completed for all requests for assistance
2
Net Cash Flow with Interest Assistance
Complete Item 2 only if Item 1 is negative and the lender is requesting interest assistance. If applicant has multiple guaranteed loans, lender is to indicate on which loans interest assistance is requested.
PART K – EZ Guarantee Documentation (Applicable Only for EZ Guarantee Applications)
1
Applicant shows the ability to repay…
Check “YES”, if your analysis shows the applicant shows the ability to repay this loan. If not, check “NO”.
Repayment can be demonstrated by such things as:
    • Scorecard analysis score of _______
    • Historical debt coverage ratio of _____
    • Pro forma debt coverage ratio of ______
    • Or other repayment capacity indicator calculated
Also include how this compares to your minimum underwriting standard or acceptable level of risk.
2
Applicant has Acceptable Credit History
Check “YES” if applicant, including all members of the entity, have acceptable credit history. If not, check “NO”.

PART L - Environmental Information (All Lender Types)

Lenders shall carefully consider questions 1 through 8 and respond with the appropriate answers for the farm operation proposed for guarantee. If the lender has questions regarding these issues, the FSA Farm Loan Manager at the local USDA Service Center should be contacted for assistance.

Lenders must complete a site visit to the operation and conduct environmental reviews as applicable.

1
HEL/WL Compliance
Check “YES” if compliance on the AD-1026 has been certified and is on file. Otherwise check “NO”.
2
Land Use
Check “YES” if proceeds from this request or project will NOT accommodate any shift in land use, ground disturbance, clearing of woody vegetation or stumps, or for drilling of a well. Otherwise check “NO”.
3
Floodplains
Check “YES” if the property on which farming activities are taking place is NOT located near or within a floodplain. Otherwise check “NO”.
4
Historical and Archaeological Sites
Check “YES” if property on which farming activities take place is NOT known to be of historical significance or contain any known archaeological sites. Otherwise check “NO”.
5
Hazardous Substances
Check “YES” if property on which the farming activities take place is NOT known to be contaminated with hazardous substances or waste and does NOT contain underground storage tanks.   Otherwise check “NO”.
6
Endangered Species
Check “YES” if there are NO known endangered species or habitats that will be disturbed by the operation. Otherwise check “NO”.
7
Environmental Compliance
Check “YES” if there are NO pending or active lawsuits regarding environmental compliance against the operator or property and there are NO environmental liens or judgements filed against the property as a result of not complying with Federal or State environmental laws.  Otherwise check “NO”.
8
State Water Quality Standards
Check “YES” if this is NOT a livestock operation. Check “NO” if this is a livestock operation and include number of animals and type of livestock.
PART M - Lender Information and Certification (All Lender Types) - Read the certification statement.
1
Lender Status
Check box that represents current lender status.
2A - G
Lender Certifies
Item G - All lenders enter the effective date of FSA-2201, Lender’s Agreement.

3A - B
Lending Institution Name, Address & Telephone Number
Enter the Lender’s name, complete mailing address and phone number (Include Area Code).
4A
Lender Tax ID Number
Enter the Lender’s 9 Digit Tax ID Number.
4B
Regulatory Agency
Enter the lender’s primary oversight agency (e.g., FDIC, OCC, FCA).
5
Email Address
Enter lender representative’s email address.
6A
Name of Lender's Representative 
Enter the name of official authorized to execute official binding documents on the lender’s behalf. 

6B
Title of Lender Representative
Enter the title of official authorized to execute official binding documents on the lender’s behalf.
7A
Signature of Authorized Lender Representative
Enter the signature of the individual whose name appears in Item 4A. The lender should promptly submit the completed application to FSA for consideration.

If you are mailing, emailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office
7B
Date
Enter the date the official authorized to execute official binding documents on the lender's behalf signed this form.
PART N - FSA USE ONLY
1A
Date Received
Insert date application is received.

1B
Date Completed
Insert date application is determined complete.
PART O – Co-Applicant / Entity Member / Co-Signer Information (If Applicable)
1A
Co-Applicant’s, Entity Member’s, or Co-Signer’s Name
Enter the co-applicant’s, entity member’s, or co-signer’s complete legal name.
1B
Co-Applicant’s, Entity Member’s, or Co-Signer’s ID Number
Enter co-applicant’s, entity member’s, or co-signer’s social security number or tax ID Number.
1C
Co-Applicant’s, Entity Member’s, or Co-Signer’s Birthdate
Enter co-applicant’s, entity member’s, or co-signer’s date of birth 
(MM-DD-YYYY).
1D
Co-Applicant’s, Entity Member’s, or Co-Signer’s Address
Enter the co-applicant’s, entity member’s, or co-signer’s complete mailing address, including physical address if different from mailing address.
1E
Residence or Headquarters
Enter county the co-applicant, entity member, or co-signor resides in or the county where the headquarters office is located if an embedded entity.
1F
Co-Applicant’s, Entity Member’s, or Co-Signer’s Telephone No.
Enter co-applicant’s, entity member’s, or co-signer’s home or business telephone number, including area code.
1G
Co-Applicant’s, Entity Member’s, or Co-Signer’s Telephone Type
Check the co-applicant’s, entity member’s, or co-signer’s telephone type (Home, Cell, Work)
1H
% Ownership
Enter the percent of the entity that is owned by the member.
1I
Co-Signer Only
Check this box if acting as co-signer only.
1J
Marital Status
Check the box that most closely corresponds to current marital status of the co-applicant or the entity member, if an individual.
1K
Citizenship Status
Check appropriate box.  If not a U.S. citizen, applicant will be asked to provide I-551 and/ or other proper documentation of immigration status as found under PRWORA (8 U.S.C. 1641)

Items 1L – 1O – Voluntary Information for Monitoring Purposes (Complete as applicable)
1L
Ethnicity
Check the appropriate box indicating your ethnicity.
1M
Race
Check the appropriate box or boxes indicating your race.
1N
Gender
Check the appropriate box indicating your gender.
1O
Veteran Status
Check the appropriate box indicating your veteran status.
Note:  If additional Co-Applicants, Entity Members, or Co-Signers; complete Items 2A – 2O.   Additional copies of Pages 5 and 6 may be attached if necessary.
PART P – Co-Applicant, Entity Member, and/or Co-Signer Certifications
Certification/ Acknowledgment
Please read the statements in this section carefully before signing.
1A
Signature of Co-Applicant or Entity Member
Enter the signature of the co-applicant or entity member.
1B
Capacity
Check “Self” if you are signing for yourself. Check “Entity Representative” if you are signing on behalf of an entity. Check both boxes if applicable.
1C 
Date
Enter the date (MM-DD-YYYY) the co-applicant or entity member signed the form.
Note:  If additional Co-Applicants, Entity Members, or Co-Signers complete Items 2A – 2C in the same manner.                                                        Additional copies of Pages 5 and 6 may be attached if necessary.
PART Q – Supporting Information for SEL/CLP lenders (For SEL/CLP Lenders Completing Non-EZ Guaranteed Loans)
1
Please attach the following
Attach the appropriate items as indicated for SEL or CLP lenders.