Individuals who will own 20% or more of the business must fill-out: Personal Income and Expense, Personal Financial Statement, Management Resume, Personal History Form and Authorization to Release Information.    


 

Thank you for your interest. The attached document is our SBA application in word format. If you have

Microsoft Word 2000, you should be able to open the document. In all cases we will need the following documents filled out.


                                                   

 

SBA APPLICATION

INSTRUCTIONS:

 

The Loan Request Form:  If you have not legally established or incorporated your company name, please provide    your preferred company name and indicate (proposed), if you will be trading under a different name list your dba/ _______________  (doing business as). Bank information is for personal as well as business accounts. Accountant and attorney should be listed if you have one. Trade references only apply if you already own the business and seeking an expansion loan.

 

Project Cost Estimates:  We will complete this form, but if you have a detailed breakout of costs please attach or include.

 

Source of Capital Injection: We need to know the sources for you to make the down payment. Copies of Bank or Financial Statements should be included.

 

Borrowers Authorization To Release Information: Needs to be signed and dated by all partners who will own 20% or more of the newly started or acquired business. 

 

Personal Income and Expense: List your expected income after the acquisition or start-up of the business should include spouse’s income (if married). Expenses should be realistically portrayed and adjusted to the living situation and/or personal expenses you will have after the purchase or opening the business. Numbers should be annualized (one year totals).

 

Personal Financial Statement:  Updated information needed for your PFS. Most commonly omitted is Section 2 (notes payable). This section refers to: Auto loans, credit cards, and personal bank loans. Omit credit cards or debt where the balance is paid off monthly. Section 5 refers to personal property like furniture, jewelry, household items and valuable collections, please list general categories with $ amounts. Section 4 should include all personal properties including home, vacation home, rental home, land and home equity loans (detailed information must be provided).

 

Management Resume: Basic Information and dates need to be filled out, but you can attach a resume if you have one. You must respond to the US citizen question or alien registration #. If you are not a US Citizen, but have permanent status in the US recognized by the INS (Immigration Naturalization Service), you can qualify. Copy of your alien registration card or green card (both sides) should be included in the application.

 

4506 –Request For Copy or Transcript of Tax Forms – Just fill-out 1(a) and 1(b) and 2(a) and 2(b) if married and filing jointly and sign and date it at the bottom of the page. You need to include 3 years of personal tax returns with your application.

 

 

Personal History:  Fill-out 1-9. Must answer truthfully questions 6-8. If you answer “yes” to any of these, you should include an explanation of circumstances, charges and outcome.  

 

 

Other documents: Required Include:  3 years personal tax returns, articles of incorporation (if incorporated), last years W-2 or 1099 form, and green card or alien registration card (if not a US citizen).

 

 

 

 

 

For Business Acquisition:                                   Start-Up or Acquisition of Franchise 

 

3 Years Corporate Tax Returns                             Total Investment Required (Start-Up Franchise)                                                                                                                   

Purchase Agreement                                              Purchase Agreement (If purchasing franchise)

Description of Business (Brochures)                     UFOC (For franchises only, and if you have a copy)

Office Lease                                                           Draft or Final Office Lease (If Available)

Financial Statement, P&L, Balance Sheet,            Business Plan (for independently run start-up businesses)

(should be no older than 45 days)                          Business Plan (for start-up franchise if one available)

 

If you need assistance on developing a business plan, visit us at: www.diamondfs.com or www.easysba.com

 

To complete the application:  After filling out the information (preferably on your computer), please email it back to us at DonJ@easysba.com or print out the total application and fax it to us at (732) 495-7058.  Please remember to mail our processing fee of $250 (Payable to Diamond Financial Services) when sending in your initial application package.  We will review the application and send an original to you for your signatures.  Then return the application and all supporting document to:

 

Diamond Financial

262 Highway 36

West Keansburg, NJ 07734

 

Should you have any questions call us at our toll free number:    (877) 508-2274

Or call for the Diamond Financial Office nearest you!

                                                  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SBA LOAN APPLICATION CHECKLIST

(FRANCHISE START-UP)

 

This checklist has been provided to assist you through the process of gathering the necessary information of the initial evaluation of your loan request.  Complete information will be necessary to process your application.  All forms are provided herein unless noted.  Please be advised that all financial statements and tax returns must have original signatures and dates.  After photocopying, please sign again and affix current date.

 

       1.         SBA LOAN APPLICATION

 

       2.         CURRENT PERSONAL FINANCIAL STATEMENTS – Copies of last three months bank, IRA, Stock and Investment statements.   

 

          3.             FORM 4506 – REQUEST FOR COPY OR TRANSCRIPT OF TAX RETURN – A form must be completed for all individuals with ownership of 20% or more of stock issued, partners, and/or guarantors of the proposed loan.  A form must also be completed for the borrowing entity, if other than a sole proprietorship.

 

       4.         PERSONAL TAX RETURNS AND W-2’S – Complete federal and state, if applicable, tax returns for the past three years.  (Copy and Sign)

 

       5.         BUSINESS FINANCIAL STATEMENTS AND TAX RETURNS – Income statements, balance sheets,                                                                         

                             and federal tax returns for three prior year-end time periods.

 

       6.         INTERIM BUSINESS FINANCIAL STATEMENT – Income statement and balance sheet dated no older than 45 days.

 

       7.         AGING OF RECIEVABLES/PAYABLES – Balanced to interim financial statement.      

 

       8.         BUSINESS PLAN – Must be provided on all start-up businesses and expansions.

 

       9.         AUTHORIZATION TO RELEASE INFORMATION – Needs to be signed and dated by all proprietors,         

                                officers, guarantors, and stockholders or partners with 20% or more of stock issued.

 

        10.       PROJECTED MONTHLY CASH FLOW FOR ONE YEAR.  Must be supplied for new   

                                businesses, business acquisitions, or if majority of funds are for Working Capital.

 

       11.       COPY OF FRANCHISE AGREEMENT AND UFOC DISCLOSURE

 

       12.       ARTICLES OF INCORPORATION AND BY-LAWS/ARTICLES OF ORGANIZATION

 

        13.       MORTGAGE STATEMENT(S) – On all existing liens for properties being pledged as collateral. – Warranty Deed(s).

 

       14.       COPY OF LEASE OR PROPOSED LEASE – If leasing commercial property.

 

       15.       PHOTOS OF EXISTING PROPERTY – (inside, outside and parking)

 

       16.       ESTIMATED COST OF CONSTRUCTION – If applicable, supported by bids.

 

       17.       LIST OF EQUIPMENT/MACHINERY TO BE PURCHASED – Include description of equipment/machinery and bids.

 

       18.       DEMOGRAPHICS – (Store Location)

 

       19.       PROCESSING FEE - $250.00 fee payable to Diamond Financial Services

 

 

           

 

SMALL BUSINESS ADMINISTRATION

FOR OFFICE USE ONLY

 

SOURCE CODE :                                 

 
LOAN REQUEST FORM

APPLICANT COMPANY

 

Fax #

     

 

Company Name

     

Telephone

     

 

Address

     

City

     

ST   

Zip

     

 

 

Contact

     

Tax ID#

     

 

Type of Business

     

Date Established

     

 

Type of Entity:

Corporation              Partnership  

Sole Proprietorship       LLC 

 

Number of Employees: Existing   

     

After This Loan

     

 

Bank Contact

     

Telephone

     

 

Account #

     

Acc. Type

Bus   Personal

 

Bank Contact

     

Telephone

     

 

Account #

     

Acc. Type

Bus   Personal

 

Bank Contact

     

Telephone

     

 

Account #

     

Acc. Type

Bus   Personal

 

                                                                                      

Professional References

 

Accountant Name

     

Telephone

               

Attorney Name

                              

Telephone

     

 

Trade References

 

Trade Reference

     

Telephone

     

Trade Reference

     

Telephone

     

 

 

OWNERSHIP OF APPLICANT COMPANY

List below all officers, directors, partners, owners & co-owners, and all stockholders with 20% or more of total stock issued.

 

NAME

 

TITLE

 

% OF OWNERSHIP

 

ANNUAL COMPENSATION

     

 

     

 

     

 

     

     

 

     

 

     

 

     

     

 

     

 

     

 

     

 

 

AFFILIATES

List below all business concerns in which the applicant company or any of the individuals listed in the ownership section above have any ownership.

 

COMPANY NAME

 

OWNER

(APPLICANT COMPANY OR INDIVIDUALS)

 

% OF

OWNERSHIP

     

 

     

 

     

     

 

     

 

     

 

 

ESTIMATED PROJECT COSTS

 

 

Land acquisition

     

New building construction / renovations

     

Construction Contingency

     

Land and Building Acquisition

     

Building Improvements / Repairs

     

Accounts Receivable

     

Acquisition of Furniture / Fixtures

     

Acquisition of Machinery / Equipment

     

Acquisition of Existing Business

     

Inventory Purchase

     

Working capital (include AP & soft costs)

     

Payoff bank loan (non-SBA associated)

     

Payoff other debt

     

Estimated Closing Costs

 

Construction Loan Fees

     

Construction Loan Interest

     

Survey Fees

     

Legal Fees

     

Franchise Fees

     

SBA Guarantee Fee

     

Lender Fees

     

Other Misc. Costs                          

     

 

 

TOTAL ESTIMATED PROJECT AMOUNT

$0.00

MINUS OWNERS EQUITY FOR PROJECT

(     )

MINUS OTHER FINANCING FOR PROJECT

(     )

TOTAL ESTIMATED LOAN AMOUNT

$0.00

 

Explanation of other financing:       

 

 



 

SOURCE OF CAPITAL INJECTION

 

 

SOURCE OF FUNDS

 

AMOUNT OF FUNDS

 

 

 

 

 

 

1.  Cash on Hand

     

 

 

 

2.  Cash in Checking Account

     

        Name:

     

 

 

        Bank:

     

 

 

        Acct#:

     

 

 

 

 

 

3.  Cash in Savings Account

     

        Name:

     

 

 

        Bank:

     

 

 

        Acct#:

     

 

 

 

 

 

4.  Sale of Investments

     

        Details:

     

 

 

 

 

5.  Finance obtained by additional mortgage on personal real estate

     

        Details:

     

 

 

 

 

6.  Sale of Asset

     

        Details:

     

 

 

 

 

7.  Business Assets (already obtained) being transferred to this business

     

        Details:

     

 

 

 

 

8.  Gift from Family Member

     

        Details:

     

 

 

 

 

9.  Injection from minority partners

     

        Details:

     

 

 

 

 

10.  Other

 

     

        Details:

     

 

 

 

 

11.  Other:

     

     

        Details:

     

 

 

 

 

 

TOTAL CAPITAL INVESTMENT

$0.00

Other information about source of funds:

 

 

     

 

 

 

 

 

 

 

Signature

 

Title

     

Date:

     

 

 

 

 

 

 


 

 


 

 


PERSONAL INCOME AND EXPENSE ANALYSIS

Name(s)

     

 

 

 

Source of Income

Annually

Gross Salary – Principal

     

                         Spouse

     

Other income:

 

  Rental

     

  Interest

     

  Dividend

     

  Other:

     

 

     

Total Income

$0.00

 

 

Expenses

 

Mortgage – Personal Residence (PITI)

     

                   Rental Property (PITI)

     

Alimony

     

Automobile Loans

     

Child Care

     

Credit Card Expenses (5% of credit balances)

     

Educational Expenses

     

Income Taxes (Based on highest amount of past 3 years)

     

Installment Loans

     

Insurance (Medical/Life)

     

Miscellaneous (minimum 10% of total income)

     

Personal Expenses

     

Property Taxes (If not included in mortgage payment(s))

     

Rental Property Expenses

     

Utilities (including telephone and cable)

     

Other Expenses

     

 

     

Total Expenses

$0.00

 

 

Net Discretionary Income (Income minus Expenses)

$0.00

Coverage Ratio (Income/Expenses)

     

 

 

 

Signature_________________________________________________________Date___________________

PERSONAL FINANCIAL STATEMENT

OMB Approval No. 3245-0188

 

 

 

U.S SMALL BUSINESS ADMINISTRATION

As of

     

Complete this form 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 or (4) any other person or entity providing a guaranty on the loan.

Name

     

Business Phone

     

Residence Address

     

Residence Phone

     

City, State, & Zip Code

     

Business Name of Applicant Borrower

     

Assets

(Omit Cents)

Liabilities

(Omit Cents)

Cash on hand & in Banks . . . . . . . . . . . . 

     

Accounts Payable . . . . . . . . . . . . .

     

Savings Account  . . . . . . . . . . . . . . . . . .

     

Notes Payable to Banks and Others        

     

IRA or Other Retirement Account . . . . .

     

     (Describe in Section 2)

 

Accounts & Notes Receivable  . . . . . . . .

     

Installment Account (Auto) . . . . . .

     Mo. Payments      

     

Life Insurance-Cash Surrender Value Only      (Complete in Section 8)

     

Installment Account (other) . . . . . .

     Mo. Payments      

     

Stocks and Bonds  . . . . . . . . . . . . . . . . . .

     (Describe in section 3)

     

Loan on Life Insurance . . . . . . . . . .

     

Real Estate  . . . . . . . . . . . . . . . . . . . . .  .

     (Describe in Section 4)

     

Mortgages on Real Estate . . . . . . . .

     (Describe in Section 4)

     

Automobile – Present Value . . . . . . . . . .

     

Unpaid Taxes  . . . . . . . . . . . . . . . . .

     (Describe in Section 6)

     

Other Personal Property . . . . . . . . . . . . .

     (Describe in Section 5)

     

Other Liabilities  . . . . . . . . . . . . . . .

     (Describe in Section 7)

     

Other Assets  . . . . . . . . . . . . . . . . . . . . . .

     

Total Liabilities . . . . . . . . . . . . . . . .

$0.00

     (Describe in Section 5)

 

Net Worth

$0.00

Total

$0.00

Total

$0.00

Section 1. Source of Income

Contingent Liabilities

Salary . . . . . . . . . . . . . . . . . . . . . . . . . . .

     

As Endorser or Co-Maker . . . . . . . .

     

Net Investment Income . . . . . . . . . . . . .

     

Legal Claims & Judgment . . . . . . .

     

Real Estate Income . . . . . . . . . . . . . . . . .

     

Provision for Federal Income Tax .

     

Other Income (Describe below)* . . . . . .

     

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.

Section 2. Notes Payable to Bank and Others

(Use attachments if necessary.  Each attachment must be identified as a part of this statement and signed.)

Name and Address of Noteholder(s)

Original

Balance

Current

Balance

Payment Amount

Frequency

(monthly, etc.)

How Secured or Endorsed/Type of Collateral

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

   SBA Form 413 (2-94)  Use 5-91  Edition until stock is exhausted.  Ref.  SOP 50-10 and 50-30

 

 

Section 3. Stocks and Bonds

(Use Attachments if necessary.  .  Each attachment must be identified as a part of this statement and signed.) 

 

Number of Shares

Name of Securities

Cost

Market Value Quotation/Exchange

Date of Quotation/Exchange

Total Value

 

     

     

     

     

     

     

 

     

     

     

     

     

     

 

     

     

     

     

     

     

 

     

     

     

     

     

     

 

Section 4. Real Estate Owned

(List each parcel separately.  Use attachments if necessary.  Each attachment must be identified as a part of this statement and signed.) 

 

 

Property A

Property B

Property C

 

Type of Property

 

 

Address

 

     

 

 

     

 

     

 

Date Purchased

     

     

     

 

Original Cost

     

     

     

 

Present Market Value

     

     

     

 

Name &

Address of  Mortgage Holder

     

     

     

     

     

     

 

Mortgage Account Number

     

     

     

 

Mortgage Balance

     

     

     

 

Amount of Payment per Month/Year

     

     

     

 

Status of Mortgage

     

     

     

 

Section 5. Other Personal Property and Other Assets 

(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment, and if delinquent, describe delinquency).

 

     

 

Section 6. Unpaid Taxes

(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches).

 

     

 

Section 7. Other Liabilities

(Describe details).

 

     

 

Section 8. Life Insurance Held.

(Give face amount and cash surrender value of policies – name of insurance company and beneficiaries).

 

     

I authorize SBA/Lender to make inquires as necessary to verify the accuracy of the statements made and to determine my creditworthiness.  I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s).  These statements are made for the purpose of either obtaining a loan or guaranteeing a loan.  I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001)

 

Signature:

 

Date:

     

Social Security Number:

     

 

Signature:

 

Date:

     

Social Security Number:

     

 

PLEASE NOTE:

 

The estimated average burden hours for the completion of this form is 1.5 hours per response.  If you have questions or comments concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget, Washington, D.C. 20503.

 

 

MANAGEMENT RESUME

Please fill in all spaces.  If and item is not applicable, please indicate as such.  You may

       include additional relevant information on a separate exhibit.  SIGN/DATE where indicated.

PERSONAL INFORMATION:

NAME

     

SS#

     

DATE OF BIRTH

     

PLACE OF BIRTH

     

HOME  TELEPHONE

     

BUSINESS TELEPHONE

     

SPOUSE’S NAME

     

SS#

     

 

PLEASE ATTACH EXPLANATIONS FOR ANY YES ANSWER BELOW

HAVE YOU OR ANY PRINCIPAL EVER PREVIOUSLY FILED BANKRUPTCY?………………..

YES NO

ARE YOU OR ANY PRINCIPAL INVOLVED IN ANY PENDING LAWSUITS? …………………..

YES NO

ARE YOU BEHIND ON ANY PERSONAL OR BUSINESS TAXES?………………………………..

YES NO

HAVE YOU OR ANY PRINCIPAL EVER PREVIOUSLY REQUESTED GOVERNMENT DEBT INCLUDING STUDENT LOANS? ……………………………………………………………………..

YES NO

ARE YOU EMPLOYED BY THE U.S. GOVERNMENT?………………………………………..……

 

YES NO

EDUCATION:

 

 

 

 

College/Technical Training - Name /Location

 

Dates Attended

 

Major

 

Degree/Certificate

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

     

 

MILITARY SERVICE BACKGROUND:

 

 

 

 

Branch of Service

     

Dates of Service

     

 

WORK EXPERIENCE:  List chronologically beginning with present employment:

 

Company Name/Location

     

 

From

     

To

     

Title

     

 

Duties

     

 

Company Name/Location

     

 

From

     

To

     

Title

     

 

Duties

     

 

Company Name/Location

     

 

From

     

To

     

Title

     

 

Duties

     

 

Signature

 

Date

 


 

 

Return Executed Copies 1, 2, and 3 to SBA

OMB APPROVAL NO.3245-0178

Expiration Date:9/30/2006

 

United States of America

 

SMALL BUSINESS ADMINISTRATION

 

        STATEMENT OF PERSONAL HISTORY

 

Please Read Carefully – Print or Type

Each member of the small business concern or the development company requesting assistance must submit this form in TRIPLICATE for filing with the SBA application.  This form must be filled out and submitted by:

1.  By the proprietor, if a sole proprietorship.

2.  By each partner, if a partnership.

3.  By each officer, director, and additionally by each holder of     20%

                                                                                                                 or more of the ownership stock, if a corporation, limited                

      liability company, or a development company.

 

Name and address of Applicant (Firm Name) ( Street, City, State, and Zip Code)

     

     

     

SBA District/Disaster Area office

     

Amount Applied for (when applicable)

     

File No. (If Known)

     

1.    Personal Statement of: (State name in full, if no middle name, state (NMN) or if initial only, indicate initial.)  List all former names used, and dates each name was used.  Use a separate sheet if necessary.

         First                              Middle                               Last

                                                                           

                                                                           

                                                                           

                                                                           

2.  Give the percentage of ownership or stock owned or to be owned in the small business concern or the Development Company         %

    Social Security No.

 

     

3. Date of Birth (Month, day, and year)

     

4. Place of Birth (City & State or Foreign Country)

     

Name and Address of participating lender or surety co. (when applicable and known).

5. U.S. Citizen?  YES    NO

If no, are you a lawful Permanent resident:   YES    NO

If no, give alien registration number:      

 

6. Present residence address:

From:         

To:      

Address:       

                     

Home Telephone No. (Include A/C)

     

Most recent prior address (omit if over 10 years ago):

From:      

To:      

Address:        

                      

Business Telephone No. (Include A/C):

     

PLEASE SEE REVERSE SIDE FOR EXPLANATIONS REGARDING DISCLOSURE OF INFORMATION AND THE USES OF SUCH INFORMATION.

 

IT IS IMPORTANT THAT THE NEXT THREE QUESTIONS BE ANSWERED COMPLETELY.  AN ARREST OR CONVICTION RECORD WILL NOT NECESSARILY DISQULAIFY YOU; HOWEVER, AN UNTRUTHFUL ANSWER WILL CAUSE YOUR APPLICATION TO BE DENIED.

 

IF YOU ANSWER “YES” TO 7, 8 OR 9, FURNISH DETAILS ON A SEPARATE SHEET.  INCLUDE DATES, LOCATION, FINES, SENTENCES, WHETHER MISDEMEANOR OR FELONY, DATES OF PAROLE/PROBATION, UNPAID FINES OR PENALTIES, NAME(S) UNDER WHICH CHARGED, AND ANY OTHER PERTINENT INFORMATION.

7. Are you presently under indictment, on parole, or probation?

         Yes       No    (If yes, indicate date parole or probation is to expire.)

8. Have you ever been charged with or arrested for any criminal offense other than a minor motor vehicle violation?  Include offenses that have been                                 dismissed, discharged, or not prosecuted    (All arrests and charges must be disclosed and explained on an attached sheet.)

         Yes       No    

9. Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for

      any criminal offense other than a minor vehicle violation?

         Yes       No     

10. I authorize the Small Business Administration Office of Inspector General to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for programs authorized by the Small Business Act, and the Small Investment Act.

CAUTION: Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a denial of your loan, surety bond, or other program participation.   A false statement is punishable under 18 USC 1001 by imprisonment of not more than five years and/or a find of not more than $10,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally insured institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000.

Signature

Title       

Date       

Agency Use Only

11.  Fingerprints Waived                                                             

                                                                        Date     Approving Authority    

               Fingerprints Required                                                          

                                                                        Date     Approving Authority

         Date Sent to OIG                            

 

1.             Cleared for Processing                                                                      

                                                                               Date     Approving Authority

         13.        Request a Character Evaluation                                               

                                                                               Date      Approving Authority

EASE NOTE: The estimated burden for completing this form is 15 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid 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 Officer for the Small Business

Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. OMB Approval 3245-0178. Please Do Not Send Forms To Omb.

 

SBA 912 (10-03) SOP 5010.4         Previous Edition Obsolete