Loan Application Checklist
For more information contact:
Thomas J. Altieri
Senior Vice President
SBA Lending Manager
602-801-5713
tom.altieri@midfirst.com
Three Years Complete Business Tax Returns
Three Years Complete Personal Tax Returns
Interim Business Financial Statement
Completed Loan Application Attached
(with spousal signature if applicable)
Member FDIC
SBA Loan Application
Page 1 of 10
Member FDIC
Business Information
Company Name ________________________________________ DBA or Franchise (if applicable) __________________________________
Real Estate Holding Company Name (if applicable) __________________________________________________________________________
Phone ___________________________ Fax ____________________________ Email _________________________________________
Street ______________________________________ Suite # _______ Website _______________________________________________
City ________________________________________ State _________ Zip Code ______________________________________________
Date Company Founded _________________________ Date Of Current Ownership _____________________ # of current locations _______
# of Employees (Current) _________________ # of Employees (after financing) ___________ Tax Identification # ________________________
Type of Organization C Corp S Corp LLC LLP LP GP Sole Proprietor State of Organization ______________
Does business currently have any plans for future locations? Yes No (If yes, how many?) ___________________________________
Do sales to any one customer exceed 10% of business’s annual revenue? Yes No
Type of Business Service Retail Wholesale Mfg. Distribution Other (Describe) ________________________
Describe products and services:
Customer Profile/Key Clients:
Major Competitors:
Ownership
List below all owners, partners, Limited Liability Corporation (LLC) members, and stockholders totaling 100% of ownership. For corporations identify all
corporate officers regardless of ownership. For a Partnership or LLC, identify the managing / general partner or managing member.
If additional owners, check here and attach a separate sheet.
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
Name ______________________________________ Title ________________________ Ownership % ___ Social Security # ___________
Address ______________________________________________ City _______________________ State _______ Zip Code ____________
SBA Loan Application
Page 2 of 10
Member FDIC
Affiliates
List below all business concerns in which the applicant company or any of the individuals listed in the Ownership Section above have 20% ownership
or controlling interest. Affiliation also exists where an individual(s) has control of the Small Business Company and another concern(s) even though the
ownership of one or both is small. If additional affiliates, check here and attach a separate sheet.
Company Name _______________________________ Owned By _________________________________________ Ownership % _______
Address ____________________________________________ # Employees __________________________________________________
Company Name _______________________________ Owned By _________________________________________ Ownership % _______
Address ____________________________________________ # Employees __________________________________________________
Company Name _______________________________ Owned By _________________________________________ Ownership % _______
Address ____________________________________________ # Employees __________________________________________________
Project Summary
Real Estate Purchase $ __________________ Working Capital $ ______________________ Business/Practice Acquisition $ ______________
Building Improvements $ _________________ Inventory $ __________________________ Other (describe) $ ________________________
Equipment Purchase $ ___________________ Debt Refinance $ ______________________ Other (describe) $ ________________________
Briefly Describe Project:
References and Professional Services
Bank Reference:
Bank Name __________________________________ Contact ______________________ Phone Number ___________________________
Address _____________________________________ City _________________________ State _________ Zip Code _________________
Professionals: (if currently available)
Accounting Firm _______________________________ Contact ______________________ Phone Number ___________________________
Attorney ____________________________________ Contact ______________________ Phone Number ___________________________
Business Debt
Please fill out the attached Notes Payable Schedule (page 9). Figures should reconcile with most recent Tax Return or Interim Financial Statement
provided to Lender.
SBA Loan Application
Page 3 of 10
Member FDIC
Owner/Guarantor Disclosures and Signatures
ADDITIONAL INFORMATION WILL BE REQUIRED TO COMPLETE YOUR LOAN REQUEST
Upon receipt of this application, a MidFirst Bank representative will contact you to discuss your transaction in further detail. Prior to final review of this
application, your representative will request other forms or documents based on your specific loan request.
IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify,
and record information that identifies each person or entity opening an account or establishing a credit relationship with the financial institution. This
requirement applies to
MidFirst Bank
. What this means for you: If you are an individual, when you open an account or apply for credit, we will ask for
your name, address, date of birth, and other information that will allow us to identify you. We may ask to see your driver’s license or other identifying
documents. If you are a business or entity, we will ask for information about your entity, including its tax identification number, address, and documents
evidencing legal incorporation, formation or existence. We may also request information about your owners, directors and executive officers.
DISCLOSURE OF RIGHT TO REQUEST SPECIFIC REASONS FOR CREDIT DENIAL GIVEN AT TIME OF APPLICATION (BUSINESS CREDIT)
If your application for business credit is denied, you have the right to receive a written statement of the specific reasons for the denial. To obtain the
statement, please contact MidFirst Bank, Attn: MidFirst Bank SBA Portfolio Manager, 40 N. Central Avenue, #2800, Phoenix, AZ 85004 within 60 days
from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request
for the statement. Applicants are not required to obtain or pay for unwanted services.
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 (provided 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, Consumer
Response Center, 600 Pennsylvania Avenue, NW, Washington, D.C. 20580, 1-877-FTC-HELP (1-877-382-4357), TTY: 1-866-653-4261, www.ftc.gov.
AUTHORIZATION TO RELEASE INFORMATION
In connection with this application for financing (and any update, extension, modification, renewal or review of such financing, if it is granted), each
of the undersigned hereby: authorizes MidFirst Bank and each of its affiliates (collectively, the “Lender”) to make all inquiries it deems necessary to
verify the accuracy of the information provided herein and to determine my creditworthiness including, without limitation, obtaining consumer and/
or business credit reports regarding me or any entity I am affiliated with. Each of the undersigned individuals hereby acknowledges that Lender will
obtain a consumer credit report concerning them. The Lender may, at any time in its sole discretion, disclose the status of the proposed financing
transaction and the credit data and other information concerning or relating to the undersigned or the proposed financing transaction to the SBA,
referral sources, franchisors, vendors, loan participants, other lenders, agents and affiliates of any undersigned or the Lender. The undersigned hereby
certify that the enclosed application information, including all attachments, exhibits, schedules, etc., is true, valid, accurate and complete as of the date
of this application. The undersigned understand that false statements may result in the denial of the application.
EACH Owner/Guarantor must sign separately as Owner/Guarantor below. Non-Owner/Guarantor spouses must sign directly below spouse’s
Owner/Guarantor Signature:
Owner/Guarantor Signature ________________________________________________________________________ Date _____________
Spouse Signature________________________________________________________________________________ Date _____________
Spouse Name _____________________________________________________ Spouse Social Security # ___________________________
(Spousal signature and Social Security number required to verify combined assets and liabilities as specified by community property laws)
Owner/Guarantor Signature ________________________________________________________________________ Date _____________
Spouse Signature________________________________________________________________________________ Date _____________
Spouse Name _____________________________________________________ Spouse Social Security # ___________________________
(Spousal signature and Social Security number required to verify combined assets and liabilities as specified by community property laws)
Owner/Guarantor Signature ________________________________________________________________________ Date _____________
Spouse Signature________________________________________________________________________________ Date _____________
Spouse Name _____________________________________________________ Spouse Social Security # ___________________________
(Spousal signature and Social Security number required to verify combined assets and liabilities as specified by community property laws)
This form must be signed by each owner, partner, or stockholder with 20% or more ownership in Applicant Company and any person or
entity providing a guaranty of the loan.
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SBA Loan Application
Page 4 of 10
Member FDIC
Owner/Guarantor Information
Please fill in all spaces. Use full first, middle, last and maiden names, no initials. If an item is not applicable, please indicate so. You may include
additional relevant information on a separate exhibit. Sign and date where indicated.
Name (First) ___________________ (Middle) __________________ (Maiden) _________________ (Last) __________________________
Social Security # _______________________ Date of Birth _________________________ Place of Birth ____________________________
Residence Phone _______________________ Business Phone _______________________ Fax ___________________________________
Residence Address (Street) ______________________________ (City) _______________________________ (State) _____ (Zip) __________
Previous Address (Street) _______________________________ (City) _______________________________ (State) _____ (Zip) __________
Lived there from ___________________ to _______________________
Spouse’s Name (First) ___________________ (Middle) ______________ (Maiden) _________________ (Last) _______________________
Spouse’s Social Security # _____________________________________
Are you a U.S. Citizen? Yes No If no, give Alien Registration Number _________________________________________________
Have you ever been charged with or convicted of any criminal offense other than a misdemeanor involving a motor vehicle violation?
Yes No If yes, furnish details in a separate exhibit.
Are you involved in any lawsuit at this time or have you ever filed for personal bankruptcy protection?
Yes No If yes, furnish details in a separate exhibit.
Have you ever obtained credit under any other name(s)?
Yes No If yes, furnish details in a separate exhibit.
Do you currently have a Trust in place?
Yes No If yes, furnish details in a separate exhibit.
Education:
College OR Technical Training Name __________________________________ Location ___________________________________
Dates Attended (From/To) ________________________ Major ___________________________________ Degree OR Certificate
Military Service Background:
Not applicable Branch _________________________________________________ Dates of service (From/To) _________________
Honorable Discharge? Yes No Rank Upon Discharge _______________________________________ Grade _________________
Work Experience: (List chronologically, beginning with present employment)
Company Name/ Location ___________________________________________________________________________________________
Dates employed (From/To) ______________________________ Title _________________________________________________________
Duties __________________________________________________________________________________________________________
Company Name/ Location ___________________________________________________________________________________________
Dates employed (From/To) ______________________________ Title _________________________________________________________
Duties __________________________________________________________________________________________________________
This form must be completed by each owner, partner, or stockholder with 20% or more ownership in Applicant Company and any person
or entity providing a guaranty of the loan.
OMB APPROVAL NO.: 3245-0188
EXPIRATION DATE: 01/31/2018


 
SBA uses the information required by this Form 413 as one of a number of data sources in analyzing the repayment ability and creditworthiness of an application for an
SBA guaranteed 7(a) or 504 loan or a guaranteed surety.
Complete this form for: (1) 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

the lender processing the application for SBA guaranty
 the Certified Development Company (CDC) processing the application for SBA guaranty
: the Surety Company or Agent processing the application for surety bond guaranty

*Alimony or child support payments should not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.
SBA Form 413 (7a/504/SBG) (09-14) 




 (Omit Cents) (Omit Cents)
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……$ ________________
(Describe in Section 8)
Stocks and Bonds…………………………………..$ ________________
(Describe in Section 3)
Real Estate…………………………………………..$ ________________
(Describe in Section 4)
Automobiles…………………………………………$ ________________
(Describe in Section 5, and include
Year/Make/Model)
Other Personal Property……………………………$ ________________
(Describe in Section 5)
Other Assets………………………………………….$ _______________
(Describe in Section 5)

Accounts Payable……………………………$ ______________
Notes Payable to Banks and Others……….$ ______________
(Describe in Section 2)
Installment Account (Auto)…………………..$ ______________
Mo. Payments $ ___________
Installment Account (Other)………………....$ ______________
Mo. Payments $ ___________
Loan(s) Against 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……………………………………….$ _____________
 

 
Salary………………………………………………….$ ________________
Net Investment Income……………………………...$ ________________
Real Estate Income………………………………….$ ________________
Other Income (Describe below)*…………………...$ ________________
As Endorser or Co-Maker…………………….$ _____________
Legal Claims & Judgments…………………..$ _____________
Provision for Federal Income Tax…………....$_____________
Other Special Debt…………………………….$ _____________
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Section 2. Notes Payable to Banks and Others. (Use attachments if necessary. Each attachment must be identified as part of this statement and signed.)
Names and Addresses of
Noteholder(s)
Original
Current
Payment
Amount
Frequency
(monthly, etc.)
How Secured or Endorsed
Type of Collateral
Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as 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 attachment if necessary. Each attachment must be identified as a part of this statement
and signed.)
Property A Property B Property C
Type of Real Estate (e.g.
Primary Residence, Other
Residence, Rental Property,
Land, etc.)
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 in detail.)
SBA Form 413 (7a/504/SBG) (09-14) Previous Editions Obsolete Page 2
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Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies – name of insurance company and
Beneficiaries.)
I authorize the SBA/Lender/Surety Company to make inquiries as necessary to verify the accuracy of the statements made and to
determine my creditworthiness.
CERTIFICATION: (to be completed by each person submitting the information requested on this form)
By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting
information submitted with this form is true and complete to the best of my knowledge. I understand that SBA or its participating
Lenders or Certified Development Companies or Surety Companies will rely on this information when making decisions regarding an
application for a loan or a surety bond. I further certify that I have read the attached statements required by law and executive order.
Signature ________________________________________ Date ____________________
Print Name _______________________________________ Social Security No. ____________________
Signature ________________________________________ Date ____________________
Print Name _______________________________________ Social Security No. ____________________
NOTICE TO LOAN AND SURETY BOND APPLICANTS: CRIMINAL PENALITIES AND ADMINISTRATIVE REMEDIES FOR
FALSE STATEMENTS:
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 or surety bond application. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by
imprisonment of not more than five years and/or a fine of up to $250,000; under 15 U.S.C. § 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, a false statement is punishable
under 18 U.S.C. § 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000. Additionally, false
statements can lead to treble damages and civil penalties under the False Claims Act, 31 U.S.C. § 3729, and other administrative
remedies including suspension and debarment.
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 officer, paper Reduction Project (3245-0188), Office
of Management and Budget, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.
SBA Form 413 (7a/504/SBG) (09-14) Previous Editions Obsolete Page 3
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PLEASE READ, DETACH, AND RETAIN FOR YOUR RECORDS
STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDER
SBA is 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. These are
contained in Parts 112, 113, and 117 of Title 13 of the Code of Federal Regulations and in Standard Operating
Procedures.
Privacy Act (5 U.S.C. 552a)
Any person can request to see or get copies of any personal information that SBA has in his or her file when that file is
retrieved 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.
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) of the Small Business Act ( the Act). 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), respectively. 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 is the disclosure of information maintained in SBA’s investigative files system of records when this information
indicates a violation or potential violation of law, whether civil, criminal, or administrative in nature. Specifically, SBA
may refer the information 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
is disclosure to other Federal agencies conducting background checks; only to the extent the information is relevant to the
requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background
and other routine uses.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) -- This is notice to you as required by the Right to 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 guaranty. 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 guaranteed loan. 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 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 a application for a loan, or concerning an approved loan or loan guarantee, as necessary
to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
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.
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 financial assistance
from SBA, including disaster assistance.
SBA Form 413 (7a/504/SBG) (09-14) Previous Editions Obsolete Page 4
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Executive Orders -- Floodplain Management and Wetland Protection (42 F.R. 26951 and 42 F.R. 26961)SBA
discourages 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 due to a future flood.
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. Businesses can be forced to cease operations or be prevented from starting operations in a
new facility. Therefore, 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 an applicant is certification that the OSHA requirements that apply to the applicant business have
been determined and that the applicant, to the best of its knowledge, is in compliance. Furthermore, applicant certifies that
it will remain in compliance during the life of the loan.
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 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.
Executive Order 11738 -- Environmental Protection (38 F.R. 251621) -- 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 environment protection legislation.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) -- These laws
require SBA to collect aggressively 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: (1) report the status of your loan(s) to credit bureaus, (2) hire a collection
agency to collect your loan, (3) offset your income tax refund or other amounts due to you from the Federal Government,
(4) suspend or debar you or your company from doing business with the Federal Government, (5) refer your loan to the
Department of Justice or other attorneys for litigation, or (6) foreclose on collateral or take other action permitted in the
loan instruments.
Immigration Reform and Control Act of 1986 (Pub. L. 99-603) -- 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. 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
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. 4821 et seq.)
Borrowers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using lead-
based 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 2 CFR 2700
1. The borrower or contractor certifies, by submission of its application for an SBA loan or bond guarantee, 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 application.
SBA Form 413 (7a/504/SBG) (09-14) Previous Editions Obsolete Page 5
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SBA Loan Application
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Member FDIC
Business Debt Detail - Notes Payable Schedule
Business/Practice Name _________________________________________________________________________________________________ Date ___________________________
Schedule of all BUSINESS NOTES ONLY, including line of credit, mortgages, installment debts, and other contractual obligations. Please indicate any notes being paid off or refinanced with loan pro-
ceeds. If subject property is held personally or in a real estate holding company, list the associated Mortgagor Note. Total of the balance due column should coincide with note balances on the interim
Business Financial Statement.
Account Number And To Whom Payable
Original
Amount
Original
Date
Balance
Due
Interest
Rate
Maturity
Date
Monthly
Payment
Collateral or
Security
How Were
Proceeds Used
Current or
Delinquant
Refinance
This Loan (Y/N)
Signature __________________________________________________________________________________________________________________ Date ____________________