| Printable Loan App |
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Print out and mail this completed form to: Valley Small Business Development Corp., 7035 N. Fruit Ave., Fresno CA 93711 or fax it to us at (559) 438-9690 VALLEY SMALL BUSINESS DEVELOPMENT CORP. LOAN and/or LOAN GUARANTEE APPLICATION Part 1 of 2 Date:________________________________ Referred by:_______________________________ Business Name:____________________________________________________________ Mailing Address:__________________________________________________________ City:___________________________________________, CA Zip______________________ Physical Address:_________________________________________________________ City:___________________________________________, CA Zip______________________ Area Code:______ Tel#___________________________ County:___________________ E-mail Address:____________________ Federal I.D. #:________________________ Current # of Employees: FT________ PT________ Projected # of Employees: FT_______ PT_______ Date Business Established:__________________ Loan Amount Requested: $___________________ Business Type: Manufacturer_____ Wholesaler_____ Construction_____ Service_____ Farming_____ Other_____ Specify Other_________________________________________________________________ Legal Structure: SOLE PROPRIETOR___ PARTNERSHIP___ CORPORATION___ OTHER___ Specify Other__________________________________________________________________ Loan Purpose (use of funds):_________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ OWNERSHIP GENDER: MALE___ FEMALE___ HANDICAPPED: YES___ NO___ OWNERSHIP ETHNICITY: ASIAN___ BLACK___ HISPANIC___ WHITE___ OTHER___ OWNERS/PRINCIPALS: Name, Home Address, Home Phone and %Owned 1. __________________________________________________________________________ 2. __________________________________________________________________________ 3. __________________________________________________________________________ 4. __________________________________________________________________________ Please list the Social Security #'s of each owner/principal and spouse. 1. Name__________________________ SS#___________________ SS#_______________ 2. Name__________________________ SS#___________________ SS#_______________ 3. Name__________________________ SS#___________________ SS#_______________ 4. Name__________________________ SS#___________________ SS#_______________ Who do you presently bank with? Bank Name and Branch__________________________________________________________ Address_______________________________________________________________________ Tel#:__________________________ Contact Person_________________________________ If any or all of the principals own real estate, it will be required as collateral for a loan or guarantee. Please initial the appropriate response below: 1. I/WE will pledge our Real Estate_____ I/WE will not pledge our Real Estate_____ 2. I/WE will pledge our Real Estate_____ I/WE will not pledge our Real Estate_____ 3. I/WE will pledge our Real Estate_____ I/WE will not pledge our Real Estate_____ 4. I/WE will pledge our Real Estate_____ I/WE will not pledge our Real Estate_____ I/We certify under penalty of perjury, that the information provided herein is true and correct and that all subsequently provided information will be a true and correct representation of the facts relating to my application: Signed:______________________________________________ DATE:________________ Signed:______________________________________________ DATE:________________ Valley Small Business Development Corp. Loan Application; part 2 of 2 RIGHT TO FINANCIAL PRIVACY ACT OF 1978 :This notice to you as required by the Right to Financial Privacy Act of 1978, of Valley Small Business Development Corporation's (hereafter VSBDC) access rights to financial records held by financial institutions that are or have been doing business with you or your business, including any financial institution participating in a loan or loan guarantee. The law provides that VSBDC 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 loan or loan guaranty agreement. VSBDC 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 VSBDC's access rights continue for the term of any loan guaranty agreement. No further notice to you of VSBDC's access rights is required during the term of any such agreement. The law also authorizes VSBDC to transfer to any Government authority, any financial records included in an application for a loan guaranty, or concerning an approved loan guaranty, as necessary to process, service or foreclose a loan guarantee or to collect on a defaulted loan guarantee. No other transfer of your financial records to another Government authority will be permitted by VSBDC except as required or permitted by law. APPLICANT'S ACKNOWLEDGEMENT:My (our) signature(s) acknowledge(s) receipt of this form, that I (we) have read it and that I (we) have a copy for my (our) files. My (our) signature(s) represent(s) my (our) agreement to comply with the requirements that VSBDC makes in connection with the approval of my (our) loan request. My (our) signature(s) also represent(s) written permission, as required by the Privacy Act, for VSBDC to release any information in my (our) loan guaranty application to the Governor of my (our) State or the Governor's designated representative in conjunction with the State's processing of my (our) application for assistance under the Guaranteed Loan Program. The undersigned applies for the loan guaranty indicated in this application to be secured by real and/or personal property as hereafter agreed and the undersigned further represents that all statements made in this application are true and are made for the purpose of obtaining this loan guaranty. Verification may be obtained from any source named in the application. The original or a copy of this application will be retained by the guarantor, even if the guaranty is not granted. I (we) fully understand that it is a federal crime punishable by fine or imprisonment or both to knowingly make any false statement/concerning any of the above facts as applicable under the provisions of Title 18, United States Code Section 141. CERTIFICATION: Applicant certifies that the information provided on and with this form, is complete and correct. Applicant authorizes Valley Small Business Development Corporation ("Valley") to obtain credit reports (including personal credit reports), copies of tax returns, and other information from the IRS and other taxing authorities, and to take such other steps as Valley deems appropriate to verify (and from time to time to re-verify) the information provided with this form. Applicant further agrees to execute and deliver to Valley such other forms, and take such other action, as Valley requests in furtherance of the foregoing. Valley will retain information received in relation to this credit request as long as Valley deems necessary to do so. Applicant authorizes Valley to release credit information concerning same to other creditors, guarantors (including agencies of the federal and/or state government), credit bureaus, credit reporters, sureties, and to Valley's agents and subsidiaries. Applicant agrees to promptly notify Valley in writing of any change in name, address, or location of assets. Applicant agrees that funds drawn on the credit facilities provided by Valley will only be used for business purposes. If you are applying for loan product guaranteed or funded by the U.S. Small Business Administration ("SBA"), then the undersigned applicant also acknowledges receipt of a copy of the following document: STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDER, certifies to have read the same, and hereby agrees to comply, whenever applicable, with the hazard insurance, lead-based paint, civil rights, or other limitations contained therein." Business Name:_______________________________________________________________ Date______________ By:_______________________________________(Name&Title) Proprietor, Partners, Principals and Guarantors Date__________ Signature______________________________________________________ Date__________ Signature______________________________________________________ |