Free SBA Form 4-i Feb 2005 ver. - Federal

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SUMBMIT COMPLETED APPLICATIONS TO LENDERS OF CHOICE
SBA Loan Number

OMB Approval No. 3245-0016

Expiration Date: 04/30/2008
Loan Submitted As:

U.S. SMALL BUSINESS ADMINISTRATION

LENDER'S APPLICATION FOR GUARANTY OR PARTICIPATION
Business Name of Applicant Applicant NAICS Code: Telephone (Inc. A/C)

Reg 7(a) CLP PLP
FIRS No. (SBA's Use)

Name of Lender

Street Address

City

State

ZIP

WE PROPOSE TO THE FOLLOWING LOAN TERMS:
Lender's Share Guaranteed Loan Amount of Loan $ Lender's Interest Rate % Per Annum % Payment Beginning Months from Date of Note If Interest Rate is to be Variable Base Rate Adjustment Period Spread SBA's Share % Monthly Payment $ Base Rate Source Term of Loan Years

CONDITIONS OF LENDER (e.g. Insurance requirements, standbys, other conditions. Use additional sheet(s))

I approve this application to SBA subject to the terms and conditions outlined above. Without the participation of SBA to the extent applied for we would not be willing to make this loan, and in our opinion the financial assistance applied for is not otherwise available on reasonable terms. I certify that none of the Lender's employees, officers, directors, or substantial stockholders (more than 10%) have a financial interest in the applicant. Lender Official (Please Type or Print Name under Signature) Title Date

ON PLP SUBMISSIONS ONLY: I approve and certify that the applicant is a small business according to the standards in 13 CFR 121, the loans proceeds will be used for an eligible purpose, and the owners and managers of the applicant business are of good character.
Approving/Certifying Lender Official (Please Type or Print Name under Signature) Title Date

FOR SBA USE ONLY
Loan Officer's Recommendations Approve Decline State Reason(s)

Signature

Title

Date

Other Recommendation if Required Approve Signature Title Decline Date

State Reason(s)

THIS BLOCK TO BE COMPLETED BY SBA OFFICIAL TAKING FINAL ACTION
Approve Signature Decline State Reason(s) Title Date

SBA FORM 4-I (2-05) PREVIOUS EDITIONS OBSOLETE

INSTRUCTIONS: Lender will complete and enclose as part of this application package, all working papers, support material, and agreements requested herein, specifically including: 1. Balance sheet and ratio analysis - comments on trends, debt to worth, and current ratio. 2. Lender's analysis of repayment ability. 3. Management skill of the applicant. 4. Collateral offered and lien position, and analysis of collateral adequacy. 5. Lender's credit experience with the applicant. Identify weaknesses.

FINANCIAL SPREAD
In Column 1 please show the most recent balance sheet figures of an existing business or the initial equity investment of a start-up business or the purchase of a business. Columns 2 and 3 are to reflect adjusting entries, the use of loan proceeds, and loan repayment. Column 4 is to reflect the balance sheet of the business immediately following loan disbursement. Base the financial analysis on Column 4 figures. BALANCE SHEET Assets Cash Accounts Rec. Inventory Other Total Current Assets
Fixed Assets
Other Assets
Total Assets
Liabilities & Net Worth
Accounts Payable
Notes Payable
Taxes
Other
SBA
Total Current Liabilities Notes Payable
SBA
Other
Total Liabilities Net Worth Total Liab. & Net Worth Profit & Loss Sales
Depreciation
Income Taxes
W/D Officer Comp.
Net Profit after Tax/Deprec. As of Fiscal Year Ends DEBIT AUDITED CREDIT UNAUDITED PRO FORMA

$

$

$

$

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $ $ $ $

$ $ $
PRIOR THREE YEARS

$ $ $
INTERIM

$ $ $
PROJECTIONS

$

$

$

$

$

$ $ $ PRO FORMA SCHEDULE OF FIXED OBLIGATIONS
YEAR 1 YEAR 2 YEAR 3

$

$
YEAR 4

$
Lender's Analysis:

$

$

$

The estimated burden for completing this form is 2 hours per response. You will not be required to respond to collection of information unless it displays a currently vaild OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W. Washington, D.C. 20416 and Desk Office for Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 30503. OMB Approval (3245-0016) PLEASE DO NOT SEND FORMS TO OMB.

SBA FORM 4-I (2-05)

PREVIOUS EDITIONS OBSOLETE