SBA Loan Application For Credit

Transcription

1 SBA Loan Application For Credit Government Guaranteed Lending Division 8245 Boone Blvd., Suite 820, Tysons Corner, VA Blair Horne VHB Commercial Lender Phone Fax

2 Introduction Virginia Heritage Bank is engaged in the general commercial banking business at its location in Tysons Corner, Virginia, and also serves the surrounding Northern Virginia communities, including DC and Maryland. Our SBA Loan Program has been specifically designed to help small business owners successfully grow their businesses with financing for commercial real estate purchases, general business loans, refinancing, business and equipment acquisition as well as for working capital. Required Received I. Loan Request This section serves as the executive summary of the financing request and provides us with a breakdown of all participants and also the sources and uses of the proposed loan. Required Received II. Business History This section provides our staff with a general understanding of your business and how the loan will benefit your growth. Fully developed business plans are typically required for Start-Up financing and in most cases you will be contacted for a brief interview for further clarification during the underwriting process. Required Received III. Business Debt Schedule This form provides a current business debt schedule of the loans noted on the current interim financial statement and is used to properly determine debt service requirements of your business. Include an additional Business Debt Schedule for each affiliate. The Debt Schedule form(s) MUST have the same date and note balances as the Interim Financial Statement(s) / Balance Sheet(s). Required Received IV. Application for Business Loan Form 4 To be signed by every individual, including spouse (if applicable), as well as each individual in the company or real estate holding company that has a 20% or more ownership interest. Required Received V. Opening Day Balance Sheet (business purchase only) This is what you expect the balance sheet to look like on the day you take over. Required Received VI. Request for Transcript of Tax Return Form 4506-T This form is used to verify all tax returns provided to the bank. This is therefore required for each set of returns being submitted including corporate and personal tax returns. Each signor on the tax return should sign this 4506-T form. For example, if the president of the company signs the tax returns, this form should be signed by that same person. Or, if the personal tax returns being verified are for a married couple, both spouses should sign the form. A copy of the 4506-T form has been included in both the business and personal sections of this application for convenience. Please make additional copies and sign as needed.

3 Introduction Personal Information- Schedule of Forms Required Received VII. Personal Financial Statement Form 413 The Personal Financial Statement (PFS) form should be completed by: Each proprietor of the business being financed Each limited partner who owns 20% or more interest and for each general partner Each stockholder owning 20% or more voting stock Any person or entity providing a guaranty on the loan Spouses, (if applicable) are to sign all pages of the PFS Please keep in mind the Personal Financial Statement includes one page regarding marital status, alimony and any other contingent liabilities Required Received VIII. Management Résumé To be completed for each individual in the company or real estate holding entity who has 20% or more ownership interest OR is an officer, director or key employee of the company. This form should be completed and used as your résumé requirement. However, if you wish to expand on your qualifications you may attach your own résumé to this form. Required Received IX. Request for Transcript of Tax Return Form 4506-T This form is used to verify personal tax returns provided to the bank. Please see detailed description of the 4506-T under Business Information Schedule of Forms, make additional copies and sign as needed. Required Received X. Statement of Personal History Form 912 Required Received XI. Request for INS Form G-845(S) (if applicable) Authorization for Virginia Heritage Bank to request alien verification information.

4 Introduction Additional Information- To be submitted by Applicant Required Received Federal Tax Returns Supply complete Federal Tax Returns on the company for the previous 3 years including all schedules and statements (include returns for all affiliates). Required Received Federal Tax Returns on all Owners Supply complete Federal Tax Returns on all owners with a minimum of 20% ownership in the company for the previous 3 years, include copies of W2s. Required Received Interim Profit & Loss Statement and Balance Sheet, not older than 60 days Required Received Copy of Completed Purchase Agreement (if applicable) Required Received Account Statements Supply last 3 months personal and/or business banking/investment account statements (first page showing balance on statement is sufficient). Attach to cash injection verification. Required Received List and Aging of Accounts Receivable & Accounts Payable matching the applicable Balance Sheet Required Received Federal Tax Returns and K-1 s for the previous 3 years on any affiliate business, partnership, or investment appearing on your most recent tax return The following legal documentation relating to your business entity is required: Required Received Documentation for Sole Proprietorship: Business License Trade, Assumed or Fictitious Business Name Statement Copy of Driver s License Required Received Documentation for Partnership: Partnership Agreement GP-1 Form (California) Business License Trade, Assumed or Fictitious Business Name Statement (if applicable) Partnership Certificate (if applicable) Required Received Documentation for Corporation: Filed Articles of Incorporation Executed Corporate Bylaws Copy of Stock Certificates issued and next blank certificate in series Business License Trade, Assumed or Fictitious Business Name Statement (if applicable) Certificate of Incorporation (if applicable) Required Received Documentation for LLC: Filed Articles of Organization Executed Operating Agreement Business License Trade, Assumed or Fictitious Business Name Statement (if applicable) Certificate of Organization (if applicable) Required Received Trustee Certificate Form (if title is to be held in the name of a Trust)

5 Business Name Address City State Zip Phone Fax Type of Business Established Type of Entity Corporation Partnership Sole Proprietorship Limited Liability Company Other: Number of Employees Existing Expected After Loan Complete as much as possible for quick processing of your loan: Bank Name Address City State Zip Accountant's Name Phone Attorney's Name Phone Seller's Name Phone (If Real Estate Broker) Land and building acquisition Acquisition of existing business New building construction Building improvements or repairs Land Acquisition Acquisition of machinery/equipment Inventory purchase Working capital (including account payable) I. Loan Request APPLICANT/BORROWER ESTIMATED PROJECT COSTS Please list below all officers, directors, partners, owners, co-owners, and stockholders. Name Title Other OWNERSHIP Payoff bank loan Other debt Closing costs for VHB loan (if applicable) Seller Carry Down Payment Total Loan Amount Requested Source of Equity Percentage of Ownership Phone AFFILIATES List bellow all business concerns in which the applicant Company or any of the individuals listed in the ownership section have any ownership. Use additional sheets if necessary. Company Name Owner (applicant, company, or individuals) Percentage of Ownership 100% I am applying for individual credit and will rely on my own income and assets to repay any loan (fill in the sections relating to applicant only) We are applying for credit together. We want you to look at all our income and assets in evaluating this application (furnish all the information requested, including information about the co-applicants) Were your gross revenues $1,000,000 or less in your previous fiscal year? If you answered "yes" and Virginia Heritage Bank denies your application for credit, you have the right to a written statement of the specific reasons for the denial. To obtain the statement please contact: Loan Processing Virginia Heritage Bank 8245 Boone Blvd. Suite 820 Tysons Corner, VA Please contact VHB within 60 days from the date you are notified of the denial. Virginia Heritage Bank will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. The notice at right describes additional protections extended to you. Equal Credit Opportunity Notice NOTICE: 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, age (providing the applicant has the capacity to enter into a binding contract); because all or a 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: Federal Reserve Consumer Help PO Box 1200 Minneapolis, MN I certify that all of the information above and all of the information provided by me in this SBA Loan Application package is true and correct to the best of my knowledge and belief. I hereby authorize the release to Virginia Heritage Bank of all credit history and information required for the purpose of processing and evaluating the applicant s credit transaction. The undersigned also permits Virginia Heritage Bank to release the applicant s credit information and otherwise exchange information regarding applicant s credit transaction to various business professionals involved in the transaction, including but not limited to, commercial real estate brokers, real estate agents, accountants, attorneys, the U.S. Small Business Administration, and third party financial institutions. Applicant Signature Title Applicant Signature Title

6 1. Who founded the company? a. When? b. Why? II. Business History 2. What experience does the ownership/management have? 3. Have there been any changes to ownership/management? 4. What is the ownership/management succession plan? 5. How many employees do you have? 6. What is your competitive advantage/niche market? 7. Who are your competitors? a. Where are they? 8. How do you keep up with developments in the industry? 9. Describe your business operations (include types of products and or services, business plan if start-up): 10. Customer profile, % of sales (i.e. Retail 45%, Wholesale 55%) Main customers / Target market: 11. How is product or service marketed? a. Does product or service have a stable or cyclical demand? b. Is it sensitive to the economy? 12. Future plans for growth / expansion: 13. How will this loan benefit your company? 14. Discuss recent industry trends:

7 III. Business Debt Schedule Company Name: This form must have the same date(s) and note balances as the current Balance Sheet. Notate each debt to be refinanced on the corresponding Business Debt Schedule Balance Sheet : Original Creditor Name/Address Copy of Note* Settlement Statement Past Due* Original (mm/dd/yy) Original Amount Original Interest Rate Original Monthly Payment Original Maturity Original Use of Loan and Collateral* Present Balance New Interest Rate New Monthly Payment Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No *If use of proceeds is for refinance, include all previous notes and settlement sheets in chronological order on this form. Signature Title

8 U. S. Small Business Administration APPLICATION FOR BUSINESS LOAN OMB Approval No Expiration : 11/30/2012 Individual Full Address Name of Applicant Business Tax I.D. No. or SSN Full Street Address of Business Tel. No. (inc. Area Code) City County State Zip Number of Employees (including subsidiaries and affiliates) Type of Business Business Established At Time of Application Bank of Business Account and Address Use of Proceeds: (Enter Gross Dollar Amounts Rounded to the Nearest Hundreds) Loan Requested If Loan is Approved Subsidiaries or Affiliates (Separate for above) Loan Request Land Acquisition New Construction/ Expansion Repair Acquisition and/or Repair of Machinery and Equipment Pay off SBA Loan Pay off Bank Loan (Non SBA Associated)* Other Debt Payment (Non SBA Associated) Inventory Purchase All Other Working Capital (including Accounts Payable) Total Loan Requested Acquisition of Existing Business Term of Loan - (Requested Maturity) Yrs. CURRENT AND PREVIOUS SBA AND OTHER GOVERNMENT DEBT: Complete the chart below if you, your business, any principal of your business, any affiliate of your business, any other business currently owned by a principal, or any business previously owned by you or a principal of your business has received or applied for any direct or guaranteed financial assistance from the Federal Government, including student loans and disaster loans. All current, previous, and pending Government debt must be listed, including loans that have been paid in full or those that resulted in a loss to the Government. (Note: Loans that resulted in a loss to the Government include loans that were charged off, compromised, or discharged as a result of bankruptcy. The amount of the loss is the outstanding principal balance of the loan that the Government had to write off after all collection activities (including compromise) were finalized.) Name of Agency Agency Loan # 1. # 2. # 3. # 4. # Borrower s Name Original Amount of Loan of Application Loan Status Outstanding Balance $ Amount of Loss to the Government. $ $ $ $ $ $ $ $ $ $ $ $ ASSISTANCE: Did you commit to pay -- or have you paid -- anyone (including the lender) to assist you in either obtaining this loan (such as a broker, consultant or referral agent) or in preparing the application or application materials for this loan (such as a loan packager)? Yes No If "yes," complete SBA Form 159 (7a) - (Fee Disclosure Form and Compensation Agreement) for each party that was paid or will be paid.) Note: The estimated burden completing this form is 12.0 hours per response. You will not be required to respond to collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to the U.S. Small Business Administration, Chief, AIB, rd St., S.W., Washington, DC and Desk Office for Small Business Administration, Office of Management and Budget, New Executive Building, room Washington, D.C OMB Approval ( ). PLEASE DO NOT SEND FORMS TO OMB. SUBMIT COMPLETED APPLICATION TO LENDER OF CHOICE. SBA Form 4 (9-09) Previous Edition Obsolete Page 1

9 ALL EXHIBITS MUST BE SIGNED AND DATED BY PERSON SIGNING THIS FORM BUSINESS INDEBTEDNESS: Furnish the following information on all outstanding installment debts, contracts, notes, and mortgages payable. Indicate by an asterisk (*) items to be paid by loan proceeds and reasons for paying them. (Present balance should agree with the latest balance sheet submitted). To Whom Payable Original Original Present Balance Rate of Maturity Monthly Security Current or Amount Interest Payment Past Due Acct. # $ $ $ Acct. # $ $ $ Acct. # $ $ $ Acct. # $ $ $ Acct. # $ $ $ MANAGEMENT (Proprietor, partners, officers, directors, all holders of outstanding stock 100% of ownership must be shown.) Use separate sheet if necessary. Name and Social Security Number Position/Title Complete Address % Owned *Veteran Status Veteran Yes No If yes, service-disabled? Yes No *Gender Race * :Amer. Indian or Alaska Native Asian Black or African-Amer. Native Haw. or Pacific Islander White *Ethnicity:Hispanic or Latino Not Hisp or Lantino *Veteran Status Veteran Yes No If yes, service-disabled? Yes No Race * :Amer. Indian or Alaska Native Asian Black or African-Amer. Native Haw. or Pacific Islander White *Ethnicity:Hispanic or Latino Not Hisp or Lantino *Veteran Status Veteran Yes No If yes, service-disabled? Yes No Race * :Amer. Indian or Alaska Native Asian Black or African-Amer. Native Haw. or Pacific Islander White *Ethnicity:Hispanic or Latino Not Hisp or Lantino *Veteran Status Veteran Yes If yes, service-disabled? Yes No No Race * :Amer. Indian or Alaska Native Asian Black or African-Amer. Native Haw. or Pacific Islander White *Ethnicity:Hispanic or Latino Not Hisp or Lantino *This data is collected for statistical purposes only. It has no bearing on the credit decision. Disclosure is voluntary. One or more boxes for race may be selected For Guaranty Loans please provide an original and one copy (Photocopy is Acceptable) of the Application Form and all Exhibits to the participating Lender. For Direct Loans submit one original copy of the application and Exhibits to SBA. 1.Submit SBA Form 912 (Statement of Personal History) for each proprietor (if sole proprietorship), partner (if a partnership), and by each officer, director, and owner of 20% or more of the company's stock (if a corporation, limited liability company or development company). 2. If your collateral consists of (A) Land and Building, (B) Machinery and Equipment, (C) Furniture and Fixtures, (D) Accounts Receivable, (E) Inventory, (F) Other, please provide an itemized list that contains serial and identification numbers for all articles that had an original value of greater than $5,000. Include a legal description of Real Estate offered as collateral. Label it Exhibit A. 3. Furnish a signed current personal balance sheet (SBA Form 413 may be used for this purpose) for (1) each proprietor; or (2) each limited partner who owns 20% or more interest and each general partner; or (3) each stockholder owning 20% or more of voting stock. Include the assets and liabilities of the spouse and any minor children. Also, include the tax i.d. number [EIN or Social Security Number (SSN)] Label it Exhibit B. 4. Include the financial statements listed below: a, b, c for the last three years; also a, b, c, and d as of the same date, - current within 90 days of filing the application; and statement e, if applicable. All information must be signed and dated. (a) Balance Sheet; (b) Profit and Loss Statement (if not available, explain why and substitute Federal income tax forms); (c) Reconciliation of Net Worth; (d) Aging of Accounts Receivable and and Payable (summary); (e) Projection of earnings for at least one year where financial statements for the last three years are unavailable or when SBA requests them, Label it Exhibit C. (Contact SBA for a referral if assistance with preparation is wanted.) 5. Provide a brief history of your company and a paragraph describing the expected benefits it will receive from the loan. Label it Exhibit D. 6. Provide a brief description similar to a resume of the education, technical and business background for all the people listed under Management. Label it Exhibit E. SBA Form 4 (9-09) Previous Edition Obsolete Page 2

10 7. Submit the name, addresses, tax I.D. number (EIN or SSN), and current personal financial statement of any co-signers who are not otherwise affiliated with the business and any guarantors for the loan not. covered by 3. above. Exhibit F. 8. Include a list of any machinery or equipment or other non-real estate assets to be purchased with loan proceeds and the cost of each item as quoted by the seller. Include the seller s name and address. Exhibit G. 9. Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? [ ]Yes [ ]No. If yes, please provide the details as Exhibit H. 10. Are you or your business involved in any pending lawsuits? [ ]Yes [ ]No. If yes, provide the details as Exhibit I. 11.Do you or your spouse or any member of your household, or anyone who owns, manages, or directs your business or their spouses or members of their households work for the Small Business Administration, Small Business Advisory Council, SCORE or ACE, any Federal Agency, or the participating lender? [ ]Yes [ ]No. If yes, please provide the name and address of the person and the office where employed. Label this Exhibit J. 12. Does your business, its owners or majority stockholders own or have a controlling interest in other businesses? [ ]Yes [ ]No. If yes, please provide their names and the relationship with your company along with financial data requested in question 4. Label this Exhibit K. 13. Do you buy from, sell to, or use the services of any concern in which someone in your company has a significant financial interest? [ ]Yes [ ]No. If yes, provide details on a separate sheet of paper. Exhibit L. 14. Is your business is a franchise, [ ]Yes [ ]No. If yes, include a copy of the franchise agreement and a copy of the FTC disclosure statement supplied to you by the Franchisor. Label this Exhibit M. CONSTRUCTION LOANS ONLY 15. Include as a separate exhibit the estimated cost of the project and a statement of the source of any additional funds. Label this Exhibit N. 16. Provide copies of preliminary construction plans and specifications. Label this as Exhibit 0. Final plans will be required prior to disbursement. EXPORT LOANS 17. Does your business currently export, or will it start exporting, pursuant to this loan (if approved)? Check here: [ ]Yes [ ]No 18. If you answered yes to item 17, what is your estimate of the total export sales this loan would support? $ 19. Would you like information on Exporting? Check here: [ ]Yes [ ]No _ COUNSELING/TRAINING 20. Have you received counseling or training from SBA (e.g., SCORE, ACE, SBDC, WBC, etc.)? Check here: [ ]Yes [ ]No AGREEMENTS AND CERTIFICATIONS AGREEMENTS: By signing below you agree to the following: (a) Agreements of non-employment of SBA Personnel. I agree that if SBA approves this application I will not, for at least two years, hire as an employee or consultant anyone that was employed by the SBA during the one year period prior to the loan disbursement. (b) Waiver of Claims. As consideration for any Management, Technical, and/or Business Development Assistance that may be provided, I waive all claims against SBA and its consultants. (c) Criminal Background. I authorize the SBA's Office of Inspector General to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for assistance under the Small Business Act. (d) Reimbursement of Expenses. I agree to pay for or reimburse SBA for the cost of any surveys, title or mortgage examinations, appraisals, credit reports, etc., performed by non-sba personnel provided I have given my consent. (e) Reporting. I agree to report to the SBA Office of the Inspector General, Washington, DC any federal government employee who offers, in return for any type of compensation, to help get this loan approved. READ THE FOLLOWING CAREFULLY -- FALSE STATE- MENTS ARE SUBJECT TO CRIMINAL PROSECUTION: If you knowingly make a false statement, you can be fined up to $250,000 and/or imprisoned for not more than five years under 18 USC 1001; if submitted to a Federally insured institution, under 18 USC 1014 by Imprisonment of not more than twenty years and/or a fine of not more than $1,000,000 CERTIFICATIONS: By signing below you certify as to the following: (a) All information in this Application and the Exhibits is true and complete to the best of your knowledge. You understand that this information is being submitted to a lender and SBA so they can decide to make a loan or give a loan guaranty, and that the lender and SBA are relying on this information. (b) You have not paid anyone employed by the Federal Government for help in getting this loan. You understand that you do not need to pay any other third-party for assistance in locating a lender or preparing this Application or Exhibits, and you certify that you will disclose all parties that were paid for such assistance to the Lender and will complete the SBA Form 159 for all such persons. (c) I have read a copy of the "Statements Required By Law And Executive Order," which is attached to this application and agree to comply with the requirements in this Notice. If Applicant is a proprietor or general partner, sign below. By: SUBMIT COMPLETED APPLICATION TO LENDER OF CHOICE. If Applicant is a Corporation, sign below: Corporate Name and Seal By: Signature of President Attested by: Signature of Corporate Secretary SBA Form 4 (9-09) Previous Edition Obsolete Page 3

11 Other than the person that signed on page 3, each Partner, each Stockholder owning 20% or more, and each Guarantor must sign below. In addition, if a husband and wife collectively own 20% or more of a company, each spouse must also sign. No one should sign more than once. Business Name: APPLICANT S CERTIFICATION READ THE FOLLOWING CAREFULLY -- FALSE STATEMENTS ARE SUBJECT TO CRIMINAL PROSECUTION: If you knowingly make a false statement, you can be fined up to $250,000 and/or imprisoned for not more than five years under 18 USC 1001; if submitted to a Federally insured institution, under 18 USC 1014 by Imprisonment of not more than twenty years and/or a fine of not more than $1,000,000 By signing below you certify as to the following: (a) You have reviewed (1) the responses to the question about debt on page 1 of the application; (2) the responses to questions 11, 12, and 13 (application-page 3), and (3) any financial statement that you were required to complete as Exhibit B or F to the application and certify that as to you personally all information in this Application and Financial Statement is true and complete to the best of your knowledge. You acknowledge that this information is being submitted to a lender and SBA so they can decide to make a loan or give a loan guaranty, and that the lender and SBA are relying on this information. (b) You have read a copy of the "Statements Required By Law And Executive Order," which is attached to this application and agree to comply with the requirements in this Notice. Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited Signature Check all that apply: [ ] guarantor [ ] owner-indicate percentage owned: [ ] [ ] partner-indicate whether [ ] general or [ ] limited SBA Form 4 (9-09) Previous Edition Obsolete Page 4

12 PLEASE READ, DETACH, AND RETAIN FOR YOUR RECORDS 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 retrievable 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. Failure to provide your social security number may not affect any right, benefit or privilege to which you are entitled. Disclosures of name and other personal identifiers are, however, 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, 69 F.R , (and as amended from time to time) for additional background and other routine uses. SBA Form 4 (9-09) Previous Edition Obsolete Page 5

13 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. 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 and 42 F.R ) 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 SBA Form 4 (5-09) Previous Edition Obsolete Page 6

14 Executive Order Environmental Protection (38 C.F.R ) 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. Debt Collection Act of 1982 Deficit Reduction Act of 1984 (31 U.S.C 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. Immigration Reform and Control Act of 1986 (Pub. L ) 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 Immigration and Naturalization Service pursuant to the Immigration Reform and Control Act of 1986 (Pub. L ). 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 et seq.) Borrowers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using leadbased 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, Debarment and Suspension (13 C.F.R. 145) 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. SBA Form 4 (4-09) Previous Edition Obsolete Page 7

15 V. Opening Day Balance Sheet Company Name ASSETS Current Assets Cash in Bank $ - Inventory - Prepaid Expenses - Other - Total Current Assets $ - Fixed Assets Machinery & Equipment $ - Furniture & Fixtures - Leasehold Improvements - Real Estate / Buildings - Other - Total Fixed Assets $ - Other Assets Specify $ - Specify - Total Other Assets $ - Total Assets $ - LIABILITIES & NET WORTH Current Liabilities Accounts Payable $ - Taxes Payable - Notes Payable (due within 12 months) - Current Portion Long-term Debt - Other current liabilities (specify) - Total Current Liabilities $ - Long-term Liabilities Bank Loans Payable (greater than 12 months) Less: Short-term Portion - Notes Payable to Stockholders - Other long-term debt (specify) - Total Long-term Liabilities $ - $ - Total Liabilities $ - Owners' Equity (Net Worth) $ - Total Liabilities & Net Worth $ -

16 Form 4506-T (Rev. January 2012) Department of the Treasury Internal Revenue Service Request for Transcript of Tax Return Request may be rejected if the form is incomplete or illegible. OMB No Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on "Order a Transcript" or call If you need a copy of your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return. 1a Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number on tax return, individual taxpayer identification number, or employer identification number (see instructions) 2a If a joint return, enter spouse s name shown on tax return. 2b Second social security number or individual taxpayer identification number if joint tax return 3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions) 4 Previous address shown on the last return filed if different from line 3 (see instructions) 5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party s name, address, and telephone number. Caution. If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your IRS transcript to the third party listed on line 5, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your transcript information, you can specify this limitation in your written agreement with the third party. 6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form number per request. a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form 1120, Form 1120A, Form 1120H, Form 1120L, and Form 1120S. Return transcripts are available for the current year and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days b Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 30 calendar days. c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 30 calendar days Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days.. 8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example, W-2 information for 2010, filed in 2011, will not be available from the IRS until If you need W-2 information for retirement purposes, you should contact the Social Security Administration at Most requests will be processed within 45 days... Caution. If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your return, you must use Form 4506 and request a copy of your return, which includes all attachments. 9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or tax period separately. Check this box if you have notified the IRS or the IRS has notified you that one of the years for which you are requesting a transcript involved identity theft on your federal tax return Caution. Do not sign this form unless all applicable lines have been completed. Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information requested. If the request applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note. For transcripts being sent to a third party, this form must be received within 120 days of the signature date. Phone number of taxpayer on line 1a or 2a Sign Here Signature (see instructions) Title (if line 1a above is a corporation, partnership, estate, or trust) Spouse s signature For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No N Form 4506-T (Rev )

17 Form 4506-T (Rev ) Page 2 Section references are to the Internal Revenue Code unless otherwise noted. What's New The IRS has created a page on IRS.gov for information about Form 4506-T at Information about any recent developments affecting Form 4506-T (such as legislation enacted after we released it) will be posted on that page. General Instructions CAUTION. Do not sign this form unless all applicable lines have been completed. Purpose of form. Use Form 4506-T to request tax return information. You can also designate (on line 5) a third party to receive the information. Taxpayers using a tax year beginning in one calendar year and ending in the following year (fiscal tax year) must file Form 4506-T to request a return transcript. Note. If you are unsure of which type of transcript you need, request the Record of Account, as it provides the most detailed information. Tip. Use Form 4506, Request for Copy of Tax Return, to request copies of tax returns. Where to file. Mail or fax Form 4506-T to the address below for the state you lived in, or the state your business was in, when that return was filed. There are two address charts: one for individual transcripts (Form 1040 series and Form W-2) and one for all other transcripts. If you are requesting more than one transcript or other product and the chart below shows two different addresses, send your request to the address based on the address of your most recent return. Automated transcript request. You can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on Order a Transcript or call Chart for individual transcripts (Form 1040 series and Form W-2 and Form 1099) If you filed an individual return and lived in: Alabama, Kentucky, Louisiana, Mississippi, Tennessee, Texas, a foreign country, American Samoa, Puerto Rico, Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, or A.P.O. or F.P.O. address Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, Washington, Wisconsin, Wyoming Connecticut, Delaware, District of Columbia, Florida, Georgia, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, West Virginia Mail or fax to the Internal Revenue Service at: RAIVS Team Stop 6716 AUSC Austin, TX RAIVS Team Stop Fresno, CA RAIVS Team Stop 6705 P-6 Kansas City, MO Chart for all other transcripts If you lived in or your business was in: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, a foreign country, or A.P.O. or F.P.O. address Connecticut, Delaware, District of Columbia, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin Mail or fax to the Internal Revenue Service at: RAIVS Team P.O. Box 9941 Mail Stop 6734 Ogden, UT RAIVS Team P.O. Box Stop 2800 F Cincinnati, OH Line 1b. Enter your employer identification number (EIN) if your request relates to a business return. Otherwise, enter the first social security number (SSN) or your individual taxpayer identification number (ITIN) shown on the return. For example, if you are requesting Form 1040 that includes Schedule C (Form 1040), enter your SSN. Line 3. Enter your current address. If you use a P. O. box, include it on this line. Line 4. Enter the address shown on the last return filed if different from the address entered on line 3. Note. If the address on lines 3 and 4 are different and you have not changed your address with the IRS, file Form 8822, Change of Address. Line 6. Enter only one tax form number per request. Signature and date. Form 4506-T must be signed and dated by the taxpayer listed on line 1a or 2a. If you completed line 5 requesting the information be sent to a third party, the IRS must receive Form 4506-T within 120 days of the date signed by the taxpayer or it will be rejected. Ensure that all applicable lines are completed before signing. Individuals. Transcripts of jointly filed tax returns may be furnished to either spouse. Only one signature is required. Sign Form 4506-T exactly as your name appeared on the original return. If you changed your name, also sign your current name. Corporations. Generally, Form 4506-T can be signed by: (1) an officer having legal authority to bind the corporation, (2) any person designated by the board of directors or other governing body, or (3) any officer or employee on written request by any principal officer and attested to by the secretary or other officer. Partnerships. Generally, Form 4506-T can be signed by any person who was a member of the partnership during any part of the tax period requested on line 9. All others. See section 6103(e) if the taxpayer has died, is insolvent, is a dissolved corporation, or if a trustee, guardian, executor, receiver, or administrator is acting for the taxpayer. Documentation. For entities other than individuals, you must attach the authorization document. For example, this could be the letter from the principal officer authorizing an employee of the corporation or the letters testamentary authorizing an individual to act for an estate. Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to establish your right to gain access to the requested tax information under the Internal Revenue Code. We need this information to properly identify the tax information and respond to your request. You are not required to request any transcript; if you do request a transcript, sections 6103 and 6109 and their regulations require you to provide this information, including your SSN or EIN. If you do not provide this information, we may not be able to process your request. Providing false or fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section The time needed to complete and file Form 4506-T will vary depending on individual circumstances. The estimated average time is: Learning about the law or the form, 10 min.; Preparing the form, 12 min.; and Copying, assembling, and sending the form to the IRS, 20 min. If you have comments concerning the accuracy of these time estimates or suggestions for making Form 4506-T simpler, we would be happy to hear from you. You can write to: Internal Revenue Service Tax Products Coordinating Committee SE:W:CAR:MP:T:M:S 1111 Constitution Ave. NW, IR-6526 Washington, DC Do not send the form to this address. Instead, see Where to file on this page.

18 PERSONAL FINANCIAL STATEMENT OMB APPROVAL NO EXPIRATION DATE: 09/30/2014 U.S. SMALL BUSINESS ADMINISTRATION As of, Complete this form for: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of the equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan. Return completed form to: 7(a) loans - to the lender processing the SBA application; 504 loans - to the Certified Development Company processing the SBA application; ALL Disaster loans - to the Disaster Processing and Disbursement Center at Kingsport Road, Fort Worth, TX ; and 8(a)/BD - applicants who are individuals claiming social and economic disadvantaged status and their spouses - electronically at or send hard copy with paper application to either of the two following offices listed below: Mail to the following address, if your firm is located in one of the states below: Mail to the following address, if your firm is located in one of the states below: Name US Small Business Administration DPCE Central Office Duty Station Parkview Towers 1150 First Avenue 10th Floor, Suite 100I King of Prussia, PA MA, ME, NH, CT, VT, RI, NY, PR (Puerto Rico), VI (US Virgin Islands), NJ, PA, MD, VA, WV, DC, DE, GA, AL, NC, SC, MS, FL, KY, TN US Small Business Administration Division of Program Certification and Eligibility 455 Market Street, 6th Floor San Francisco, CA IL, OH, MI, IN, MN, WI, TX, NM, AR, LA, OK, MO, IA, NE, KS, CO, WY, ND, MT, UT, SD, CA, HI, GU (GUAM), NV, AZ, WA, AK, ID, OR Business Phone Residence Address Residence Phone City, State, & Zip Code Business Name of Applicant/Borrower ASSETS Cash on hand & in Banks Savings Accounts IRA or Other Retirement Account (Describe in Section 5) Accounts & Notes Receivable (Describe in Section 5) Life Insurance-Cash Surrender Value Only (Complete Section 8) Stocks and Bonds (Describe in Section 3) Real Estate (Describe in Section 4) Automobiles - Total Present Value (Describe in Section 5, and include Year/Make/Model) Other Personal Property (Describe in Section 5) Other Assets (Describe in Section 5) Total Section 1. Source of Income Salary Net Investment Income Real Estate Income Other Income (Describe below)* (Omit Cents) LIABILITIES (Omit Cents) $ Accounts Payable $ $ Notes Payable to Banks and Others $ $ (Describe in Section 2) Installment Account (Auto) $ $ Mo. Payments $ $ Installment Account (Other) $ Mo. Payments $ $ Loan on Life Insurance $ Mortgages on Real Estate $ $ (Describe in Section 4) Unpaid Taxes $ $ (Describe in Section 6) Other Liabilities $ $ (Describe in Section 7) Total Liabilities $ $ Net Worth $ $ Total $ Contingent Liabilities $ As Endorser or Co-Maker $ $ Legal Claims & Judgments $ $ Provision for Federal Income Tax $ $ Other Special Debt $ Description of Other Income in Section 1. *Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income. SBA Form 413 (05-12) Previous Editions Obsolete 1