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."
